Evolution of the thirst mechanism in Homo: The need and limitations of thirst and hydration

There is a view that the perception of thirst and actual body fluid balance may affect cognitive and exercise performance. The evolutionary evidence suggests that our survival was dependent on our ability to sweat profusely when hunting during the heat of the day (persistence hunting), so if water deficits were not tolerated, consequently the thirst mechanism would limit our persistence hunting capability. This also means that hunting and searching for water was undertaken with some extent of water deficit, and in turn suggests that performance; physical and cognitive, was conducted with a degree of dehydration. Given the current views on the maintenance of body water for performance, there is a need to evaluate the evidence relating to tolerance limits for water deficits with respect to both physical and cognitive performance. This review considers the thirst mechanism and the conditions and selective pressures under which this might have evolved. Consideration will be given to how the thirst mechanism influences our physical and cognitive performance. The review suggests that Homo developed appropriate tolerances for water deficits and thirst perception, with a safety margin that prevented detrimental declines in physical and cognitive performance to the point of inhibiting corrective action. This would have offered a selective advantage, enabling the search for water and functioning adequately during periods of water scarcity.

Study on Sensing Urine Concentrations in Water Using a Microwave Sensor Based on Hilbert Structure

In this study, a two-port network-based microwave sensor for liquid characterization is presented. The suggested sensor is built as a miniature microwave resonator using the third iteration of Hilbert's fractal architecture. The suggested structure is used with the T-resonator to raise the sensor quality factor. The suggested sensor is printed on a FR4 substrate and has a footprint of 40×60×1.6mm3. Analytically, a theoretical investigation is made to clarify how the suggested sensor might function. The suggested sensor is created and put to the test in an experiment. Later, two pans to contain the urine Sample Under Test (SUT) are printed on the sensor. Before loading the SUT, it is discovered that the suggested structure's frequency resonance is 0.46 GHz. An 18 MHz frequency shift is added to the initial resonance after the pans are printed. They monitor the S-parameters in terms of S12 regarding the change in water content in the urine samples, allowing for the sensing component to be completed. As a result, 10 different samples with varying urine percentages are added to the suggested sensor to evaluate its ability to detect the presence of urine. Finally, it is discovered that the suggested process' measurements and corresponding simulated outcomes agreed quite well.

Origins of thirstiness sensation and current food solutions

The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.

Repeatability of Ad Libitum Water Intake during Repeated 1 h Walking/Jogging Exercise Sessions Conducted under Hot Ambient Conditions

A drinking strategy aiming to replace a given percentage of the sweat losses incurred during exercise should result in reproducible fluid intake volume and, hence, fluid balance from one exercise session to the other performed under similar scenarios. Whether this may also be the case with ad libitum drinking during exercise is unclear. We characterized the repeatability of ad libitum water intake during repeated 1 h exercise sessions and examined its effect over time on fluid balance and selected physiological functions and perceptual sensations. Twelve (3 women) healthy individuals participated in this study. At weekly intervals, they completed four 2 × 30 min walking/jogging exercise bouts (55% V˙O2max, 40 °C, 20-30% relative humidity) interspersed by a 3 min recovery period. During exercise, participants consumed water (20 °C) ad libitum. There were no significant differences among the four exercise sessions for absolute water intake volume (~1000 mL·h-1), percent body mass loss (~0.4%), sweat rate (~1300 mL·h-1) and percent of sweat loss replaced by water intake (~80%). Heart rate, rectal temperature, and perceived thirst and heat stress did not differ significantly between the first and fourth exercise sessions. Perceived exertion was significantly lower during the fourth vs. the first exercise session, but the difference was trivial (<1 arbitrary unit). In conclusion, ad libitum water intake during four successive identical 1 h walking/jogging sessions conducted in the heat will result in similar water intake volumes and perturbations in fluid balance, heart rate, rectal temperature, and perceived thirst, heat stress and exertion.

Post-Exercise Voluntary Drinking Cessation Is Associated with the Normalization of Plasma Osmolality and Thirst Perception, but Not of Urine Indicators or Net Fluid Balance

Post-exercise rehydration has been widely studied, with particular emphasis on retention of ingested fluid; comparatively little research has been conducted on why we drink more or less. To identify physiological values corresponding to voluntary drinking cessation (VDC), nine males exercised intermittently at 70−80% HRmax in the heat (WBGT = 28.1 ± 0.7 °C) to achieve a dehydration of approximately 4.0% body mass (BM). After exercise, participants were instructed to drink water as long and as much as they needed. Urine color (Ucolor), specific gravity (USG), osmolality (Uosm), plasma osmolality (Posm), fullness, BM, and thirst perception (TP) were measured pre- and post-exercise and at VDC. Each variable was compared for the three points in time with a one-way ANOVA. Participants reached dehydration of −3.6 ± 0.3% BM. Pre-exercise USG (1.022 ± 0.004) was lower than at VDC (1.029 ± 0.004, p = 0.022), Uosm did not change over time (p = 0.217), and Ucolor was lower pre-exercise (3.4 ± 0.7) vs. post-exercise (5.5 ± 1.23, p = 0.0008) and vs. VDC (6.3 ± 1.1, p < 0.0001). Posm showed a difference between pre-exercise (289.5 ± 2.3) and post-exercise (297.8 ± 3.9, p = 0.0006) and between post-exercise and VDC (287.3 ± 5.4, p < 0.0001). TP post-exercise (96.4 ± 4.34) was significantly higher than pre-exercise (36.2 ± 19.1) and VDC (25.0 ± 18.2, p < 0.0001). At VDC, participants had recovered 58.7 ± 12.1% of BM loss. At the point of voluntary drinking cessation, Posm and thirst perception had returned to their pre-exercise values, while rehydration relative to initial BM was still incomplete.

An accurate wearable hydration sensor: Real-world evaluation of practical use

A wearable body hydration sensor employing photoplethysmographic and galvanic biosensors was field evaluated using 240 human participants with equal numbers of men and women volunteers. Monitoring of water mass loss due to perspiration was performed by medical balance measurements following one of two different treadmill physical exercise regimens over 90 minutes in 15-minute intervals with intervening 10-minute rest periods. Participants wore two different models of the dehydration body monitor device mated to commercially-available smartwatches (Samsung Gear S2 and Samsung Gear Fit2). Device output was recorded by Bluetooth wireless link to a standard smartphone in 20-second blocks. Comparison of the devices with the standard measurement method (change in body mass measured by medical balance) indicated very close agreement between changes in body water mass and device output (percent normalized mean root square error averaged approximately 2% for all participants). Bland-Altman analyses of method agreement indicated that <5% of participant values fell outside of the 95% confidence interval limits of agreement and all measured value differences were normally distributed around the line of equality. The results of this first-ever field trial of a practical, wearable hydration monitor suggests that this device will be a reliable tool to aid in geriatric hydration monitoring and physical training scenarios.

Prevalence of Dehydration and the Relationship with Fluid Intake and Self‐Assessment of Hydration Status in Czech First League Soccer Players

The objective of this cross-sectional study was to evaluate the hydration status of Czech First League soccer players, and to compare the reported fluid intake, perceived fluid intake and thirst sensation of euhydrated (EU) and dehydrated (DE) players. The study involved 124 Czech male professional soccer players (age 25.2±5.0 years) participating in annual winter, pre-season laboratory testing. Hydration status was assessed based on urine specific gravity (USG), euhydration was set at USG≤1.020. Fluid intake and thirst perception were evaluated by a questionnaire. The sample mean for USG was 1.021±0.008, 56% of players were dehydrated. Reported daily fluid intake was significantly (p<0.001, d=0.95, large effect) higher in EU compared to DE players. Daily fluid intake negatively correlated with USG (rS=-0.46, p<0.001, medium effect). The fluid intake perception score was significantly (p=0.005, d=0.54, medium effect) better in EU compared to DE players. Reported intake perception scores negatively correlated with USG (rS=-0.32, p<0.001, medium effect). However, there was no correlation (rS=-0.09, p=0.34, trivial effect) between thirst perception scores and USG. Thirst perception scores were not significantly different between EU and DE players (p=0.35, d=0.18, trivial effect). Our results indicated that self-assessment of both daily fluid intake and perceived fluid intake matched with objective hydration status, while self-assessment of thirst perception was not an appropriate indicator of hydration status in elite soccer players.

Differential Microstrip Sensor for Complex Permittivity Characterization of Organic Fluid Mixtures

A microstrip highly sensitive differential sensor for complex permittivity characterization of urine samples was designed, fabricated and tested. The sensing area contains two pairs of open-stub resonators, and the working frequency of the unloaded sensor is 1.25 GHz. The sensor is easily implemented on an affordable substrate FR-4 Epoxy with a thickness of 1.6 mm. A Teflon beaker is mounted on the sensor without affecting the measurements. Numerically, liquid mixtures of water and urine at different percentages were introduced to the proposed sensor to evaluate the frequency variation. The percentage of water content in the mixture varied from 0% (100% urine) to 100% (0% urine) with a step of 3.226%, thus giving 32 data groups of the simulated results. Experimentally, the mixtures of: 0% urine (100% water), 20% urine (80% water), 33% urine (66% water), 50% urine (50% water), 66% urine (33% water), and 100% urine (0% water) were considered for validation. The complex permittivity of the considered samples was evaluated using a nonlinear least square curve fitting in MATLAB in order to realize a sensing sensitivity of about 3%.

Relationships Between WUT (Body Weight, Urine Color, and Thirst Level) Criteria and Urine Indices of Hydration Status

BACKGROUND

A Venn diagram consisting of percentage body mass loss, urine color, and thirst perception (weight, urine, thirst [WUT]) has been suggested as a practical method to assess hydration status. However, no study to date has examined relationships between WUT and urine hydration indices. Thus, the purpose of this study was to investigate relationships between urine specific gravity, urine osmolality, and the WUT criteria.

HYPOTHESIS

Urine specific gravity and urine osmolality indicate hypohydration when the WUT criteria demonstrate hypohydration (≥2 markers).

STUDY DESIGN

Laboratory cohort study.

LEVEL OF EVIDENCE

Level 3.

METHODS

A total of 22 women (mean ± SD; age, 20 ± 1 years; mass, 65.4 ± 12.6 kg) and 21 men (age, 21 ± 1 years; body mass, 78.7 ± 14.6 kg) participated in this study. First morning body mass, urine color, urine specific gravity, urine osmolality, and thirst level were collected for 10 consecutive days in a free-living situation. Body mass loss >1%, urine color >5, and thirst level ≥5 were used as the dehydration thresholds. The number of markers that indicated dehydration levels were counted and categorized into either 3, 2, 1, or 0 WUT markers that indicated dehydration. One-way analysis of variance with Tukey pairwise comparisons was used to assess the differences in urine specific gravity and urine osmolality between the different number of WUT markers.

RESULTS

Urine specific gravity in 3 WUT markers (mean ± SD [effect size], 1.021 ± 0.007 [0.57]; P = 0.025) and 2 WUT markers (1.019 ± 0.010 [0.31]; P = 0.026) was significantly higher than 1 WUT marker (1.016 ± 0.009). Urine mosmolality in 2 WUT markers (705 ± 253 mOsmol [0.43]; P = 0.018) was significantly higher than 1 WUT (597 ± 253 mOsmol). Meeting at least 2 WUT markers resulted in sensitivities of 0.652 (2 WUT criteria met) and 0.933 (3 WUT criteria met) to detect urine osmolality >700 mOsmol.

CONCLUSION

These results suggest that when 3 WUT markers are met, urine specific gravity and urine osmolality were greater than euhydration cutoff points. The WUT criterion is a useful tool to use in field settings to assess hydration status when first morning urine sample was used.

CLINICAL RELEVANCE

Athletes, coaches, sports scientists, and medical professionals can use WUT criteria to monitor dehydration with reduced cost and time.

Hydration Marker Diagnostic Accuracy to Identify Mild Intracellular and Extracellular Dehydration

Identifying mild dehydration (≤2% of body mass) is important to prevent the negative effects of more severe dehydration on human health and performance. It is unknown whether a single hydration marker can identify both mild intracellular dehydration (ID) and extracellular dehydration (ED) with adequate diagnostic accuracy (≥0.7 receiver-operating characteristic-area under the curve [ROC-AUC]). Thus, in 15 young healthy men, the authors determined the diagnostic accuracy of 15 hydration markers after three randomized 48-hr trials; euhydration (water 36 ml·kg-1·day-1), ID caused by exercise and 48 hr of fluid restriction (water 2 ml·kg-1·day-1), and ED caused by a 4-hr diuretic-induced diuresis begun at 44 hr (Furosemide 0.65 mg/kg). Body mass was maintained on euhydration, and dehydration was mild on ID and ED (1.9% [0.5%] and 2.0% [0.3%] of body mass, respectively). Urine color, urine specific gravity, plasma osmolality, saliva flow rate, saliva osmolality, heart rate variability, and dry mouth identified ID (ROC-AUC; range 0.70-0.99), and postural heart rate change identified ED (ROC-AUC 0.82). Thirst 0-9 scale (ROC-AUC 0.97 and 0.78 for ID and ED) and urine osmolality (ROC-AUC 0.99 and 0.81 for ID and ED) identified both dehydration types. However, only the thirst 0-9 scale had a common dehydration threshold (≥4; sensitivity and specificity of 100%; 87% and 71%, 87% for ID and ED). In conclusion, using a common dehydration threshold ≥4, the thirst 0-9 scale identified mild intracellular and ED with adequate diagnostic accuracy. In young healthy adults', thirst 0-9 scale is a valid and practical dehydration screening tool.

Fluid Balance, Sweat Na+ Losses, and Carbohydrate Intake of Elite Male Soccer Players in Response to Low and High Training Intensities in Cool and Hot Environments

Hypohydration increases physiological strain and reduces physical and technical soccer performance, but there are limited data on how fluid balance responses change between different types of sessions in professional players. This study investigated sweat and fluid/carbohydrate intake responses in elite male professional soccer players training at low and high intensities in cool and hot environments. Fluid/sodium (Na⁺) losses and ad-libitum carbohydrate/fluid intake of fourteen elite male soccer players were measured on four occasions: cool (wet bulb globe temperature (WBGT): 15 ± 7 °C, 66 ± 6% relative humidity (RH)) low intensity (rating of perceived exertion (RPE) 2–4, m·min⁻¹ 40–46) (CL); cool high intensity (RPE 6–8, m·min⁻¹ 82–86) (CH); hot (29 ± 1 °C, 52 ± 7% RH) low intensity (HL); hot high intensity (HH). Exercise involved 65 ± 5 min of soccer-specific training. Before and after exercise, players were weighed in minimal clothing. During training, players had ad libitum access to carbohydrate beverages and water. Sweat [Na⁺] (mmol·L⁻¹), which was measured by absorbent patches positioned on the thigh, was no different between conditions, CL: 35 ± 9, CH: 38 ± 8, HL: 34 ± 70.17, HH: 38 ± 8 (p = 0.475). Exercise intensity and environmental condition significantly influenced sweat rates (L·h⁻¹), CL: 0.55 ± 0.20, CH: 0.98 ± 0.21, HL: 0.81 ± 0.17, HH: 1.43 ± 0.23 (p =0.001), and percentage dehydration (p < 0.001). Fluid intake was significantly associated with sweat rate (p = 0.019), with no players experiencing hypohydration > 2% of pre-exercise body mass. Carbohydrate intake varied between players (range 0–38 g·h⁻¹), with no difference between conditions. These descriptive data gathered on elite professional players highlight the variation in the hydration status, sweat rate, sweat Na⁺ losses, and carbohydrate intake in response to training in cool and hot environments and at low and high exercise intensities.

Reviewing the current methods of assessing hydration in athletes

Background

Despite a substantial body of research, no clear best practice guidelines exist for the assessment of hydration in athletes. Body water is stored in and shifted between different sites throughout the body complicating hydration assessment. This review seeks to highlight the unique strengths and limitations of various hydration assessment methods described in the literature as well as providing best practice guidelines.

Main body

There is a plethora of methods that range in validity and reliability, including complicated and invasive methods (i.e. neutron activation analysis and stable isotope dilution), to moderately invasive blood, urine and salivary variables, progressing to non-invasive metrics such as tear osmolality, body mass, bioimpedance analysis, and sensation of thirst. Any single assessment of hydration status is problematic. Instead, the recommended approach is to use a combination, which have complementary strengths, which increase accuracy and validity. If methods such as salivary variables, urine colour, vital signs and sensation of thirst are utilised in isolation, great care must be taken due to their lack of sensitivity, reliability and/or accuracy. Detailed assessments such as neutron activation and stable isotope dilution analysis are highly accurate but expensive, with significant time delays due to data analysis providing little potential for immediate action. While alternative variables such as hormonal and electrolyte concentration, bioimpedance and tear osmolality require further research to determine their validity and reliability before inclusion into any test battery.

Conclusion

To improve best practice additional comprehensive research is required to further the scientific understanding of evaluating hydration status.

UEFA expert group statement on nutrition in elite football. Current evidence to inform practical recommendations and guide future research

Football is a global game which is constantly evolving, showing substantial increases in physical and technical demands. Nutrition plays a valuable integrated role in optimising performance of elite players during training and match-play, and maintaining their overall health throughout the season. An evidence-based approach to nutrition emphasising, a 'food first' philosophy (ie, food over supplements), is fundamental to ensure effective player support. This requires relevant scientific evidence to be applied according to the constraints of what is practical and feasible in the football setting. The science underpinning sports nutrition is evolving fast, and practitioners must be alert to new developments. In response to these developments, the Union of European Football Associations (UEFA) has gathered experts in applied sports nutrition research as well as practitioners working with elite football clubs and national associations/federations to issue an expert statement on a range of topics relevant to elite football nutrition: (1) match day nutrition, (2) training day nutrition, (3) body composition, (4) stressful environments and travel, (5) cultural diversity and dietary considerations, (6) dietary supplements, (7) rehabilitation, (8) referees and (9) junior high-level players. The expert group provide a narrative synthesis of the scientific background relating to these topics based on their knowledge and experience of the scientific research literature, as well as practical experience of applying knowledge within an elite sports setting. Our intention is to provide readers with content to help drive their own practical recommendations. In addition, to provide guidance to applied researchers where to focus future efforts.

Water Consumption during a School Day and Children's Short-Term Cognitive Performance: The CogniDROP Randomized Intervention Trial

There is still little research examining the relationship between water consumption in school and specific cognitive performance. The aim of this cluster-randomized intervention CogniDROP trial was to investigate the short-term effects of drinking water during the morning on executive functions. The participants were from the 5^th and 6^th grade of a comprehensive school in Germany (14 classes, n = 250, 61.6% boys). The classes were randomly divided into an intervention group (an education on healthy drinking behavior and a promotion of water consumption) and a control group. A battery of computerized tasks (Switch Task, 2-Back Task, Corsi Block-Tapping Task and Flanker Task) was used to test executive functions. Urine color and thirst were evaluated to check the hydration level. Physical activity over the past 24 h was measured using GT3X ActiGraph. A non-linear relationship was observed between the amount of drinking water and executive performance. Consuming water up to 1000 mL (or up to 50% of Total Water Intake) had benefits during memory tasks. Urine color and number of steps on the study day correlated with water consumed. The results suggest that a water-friendly environment supports school-aged children in adequate water intake resulting in better cognitive performance, especially short-term memory.

The Validity of Urine Color as a Hydration Biomarker within the General Adult Population and Athletes: A Systematic Review

Frequent monitoring of hydration status may help to avoid the adverse effects of dehydration. Other than urine color assessment, hydration assessment methods are largely impractical for the general population and athletes to implement on a routine basis. Despite its widespread use, the validity of urine color as an indicator of hydration status has not been systematically evaluated. The objective of this systematic review is to determine the validity of urine color evaluation as a hydration status assessment method in the general adult population, older adults, and athletes. Using the PRISMA guidelines, electronic databases were searched to identify original research articles of all study design types for inclusion. Of the 424 articles screened, 10 met inclusion criteria. Most studies compared urine color to either urinary specific gravity or urine osmolality, and reported significant associations (r) ranging from 0.40 to 0.93. Lower correlations were noted in studies of adults aged >60 years. Studies generally reported a high sensitivity of urine color as a diagnostic tool for detecting dehydration and supported the ability of this method to distinguish across categories of hydration status. Research is needed to determine if clinicians, patients, and clients can accurately utilize this method in clinical and real-world settings. Future research is also needed to extend these findings to other populations, such as children.Key teaching pointsInadequate hydration can lead to impairments in physical performance and cognitive function.Methods used to assess hydration status include plasma/serum osmolality, urinary specific gravity (USG), urine osmolality (Uosm), change in body weight, urine volume, and urine color.Urine color assessment is a practical method that is routinely used in clinical, athletic, and other settings. The validity of this method has not been systemically evaluated.Available research was limited to 10 articles.Validity of this method was generally supported; however, research has not investigated the validity of this method by clinicians, patients and clients.

Distinguishing Low and High Water Consumers-A Paradigm of Disease Risk

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.

Thirst and Drinking Paradigms: Evolution from Single Factor Effects to Brainwide Dynamic Networks

The motivation to seek and consume water is an essential component of human fluid–electrolyte homeostasis, optimal function, and health. This review describes the evolution of concepts regarding thirst and drinking behavior, made possible by magnetic resonance imaging, animal models, and novel laboratory techniques. The earliest thirst paradigms focused on single factors such as dry mouth and loss of water from tissues. By the end of the 19th century, physiologists proposed a thirst center in the brain that was verified in animals 60 years later. During the early- and mid-1900s, the influences of gastric distention, neuroendocrine responses, circulatory properties (i.e., blood pressure, volume, concentration), and the distinct effects of intracellular dehydration and extracellular hypovolemia were recognized. The majority of these studies relied on animal models and laboratory methods such as microinjection or lesioning/oblation of specific brain loci. Following a quarter century (1994–2019) of human brain imaging, current research focuses on networks of networks, with thirst and satiety conceived as hemispheric waves of neuronal activations that traverse the brain in milliseconds. Novel technologies such as chemogenetics, optogenetics, and neuropixel microelectrode arrays reveal the dynamic complexity of human thirst, as well as the roles of motivation and learning in drinking behavior.

The Utility of Thirst as a Measure of Hydration Status Following Exercise-Induced Dehydration

The purpose of this study was to examine the perception of thirst as a marker of hydration status following prolonged exercise in the heat. Twelve men (mean ± SD; age, 23 ± 4 y; body mass, 81.4 ± 9.9 kg; height, 182 ± 9 cm; body fat, 14.3% ± 4.7%) completed two 180 min bouts of exercise on a motorized treadmill in a hot environment (35.2 ± 0.6 °C; RH, 30.0 ± 5.4%), followed by a 60 min recovery period. Participants completed a euhydrated (EUH) and hypohydrated (HYPO) trial. During recovery, participants were randomly assigned to either fluid replacement (EUH_FL and HYPO_FL; 10 min ad libitum consumption) or no fluid replacement (EUH_NF and HYPO_NF). Thirst was measured using both a nine-point scale and separate visual analog scales. The percent of body mass loss (%BML) was significantly greater immediately post exercise in HYPO (HYPO_FL, 3.0% ± 1.2%; HYPO_NF, 2.6% ± 0.6%) compared to EUH (EUH_FL, 0.2% ± 0.7%; EUH_NF, 0.6% ± 0.5%) trials (p < 0.001). Following recovery, there were no differences in %BML between HYPO_FL and HYPO_NF (p > 0.05) or between EUH_FL and EUH_NF (p > 0.05). Beginning at minute 5 during the recovery period, thirst perception was significantly greater in HYPO_NF than EUH_FL, EUH_NF, and HYPO_FL (p < 0.05). A 10 min, ad libitum consumption of fluid post exercise when hypohydrated (%BML > 2%), negated differences in perception of thirst between euhydrated and hypohydrated trials. These results represent a limitation in the utility of thirst in guiding hydration practices.

Climate conditions and work-related fatigue among professional drivers

The possible associations between climate parameters and drivers' fatigue have not been subject to specific studies thus far. We have undertaken a study to investigate whether the particular climate parameters are related to fatigue perception by motor vehicle drivers. The study was performed from July to October. Each driver was surveyed four times: before and after workshift on a monotonous route outside the city center (MR), and on a heavy traffic route in the city center (HTR). The study was conducted among 45 city bus drivers aged 31-58 years (43.7 ± 7.9), seniority as driver 3-34 years (14.7 ± 8.6). Data on climate conditions (ambient temperature, air pressure, humidity, wind speed, precipitations) on particular study days was obtained from the Institute of Meteorology and Water Management, National Research Institute Warsaw, Poland. Fatigue was assessed using the Fatigue Assessment Questionnaire, developed at Nofer Institute of Occupational Medicine (Lodz, Poland). The total level of fatigue was significantly (p = 0.045) higher after driving on HTR than on MR. The number of symptoms was also significantly higher (p < 0.05) among drivers working on HTR. After MR, significant correlations were found between wind speed and heavy eyelid feeling, being prone to forgetting, eye strain, frequent blinking, and between ambient temperature and feeling thirsty. After HTR feeling thirsty, tiredness and difficulty in making decisions correlated with ambient temperature and feeling thirsty with wind speed. Climate conditions can modify the drivers fatigue; therefore, we should be aware of their impact on well-being.

Alkaline water improves exercise-induced metabolic acidosis and enhances anaerobic exercise performance in combat sport athletes

Hydration is one of the most significant issues for combat sports as athletes often use water restriction for quick weight loss before competition. It appears that alkaline water can be an effective alternative to sodium bicarbonate in preventing the effects of exercise-induced metabolic acidosis. Therefore, the main aim of the present study was to investigate, in a double blind, placebo controlled randomized study, the impact of mineral-based highly alkaline water on acid-base balance, hydration status, and anaerobic capacity. Sixteen well trained combat sport athletes (n = 16), were randomly divided into two groups; the experimental group (EG; n = 8), which ingested highly alkaline water for three weeks, and the control group (CG; n = 8), which received regular table water. Anaerobic performance was evaluated by two double 30 s Wingate tests for lower and upper limbs, respectively, with a passive rest interval of 3 minutes between the bouts of exercise. Fingertip capillary blood samples for the assessment of lactate concentration were drawn at rest and during the 3rd min of recovery. In addition, acid-base equilibrium and electrolyte status were evaluated. Urine samples were evaluated for specific gravity and pH. The results indicate that drinking alkalized water enhances hydration, improves acid-base balance and anaerobic exercise performance.

Evaluation of the intensity and discomfort of perioperative thirst

Abstract Objective: To evaluate the intensity and discomfort of perioperative thirst and related factors during anesthesia recovery. Method: This is a quantitative, cross-sectional, descriptive study. Results: Of the 203 participants, 182 (89.6%) reported they were thirsty. The mean intensity of thirst was 6.9 measured using a verbal numerical scale of 0 to 10 and discomfort was 7.3 on a scale of 0 to 14. All attributes evaluated by the scale were cited including dry mouth and desire to drink water (87.3%), dry lips (79.1%), thick tongue feeling (43.4%), thick saliva (56.5%), dry throat (75.2%) and bad taste in the mouth (63.1%). There was a positive correlation between the intensity of thirst and discomfort assessed by the scale (Spearman coefficient: 0.474; p-value: <0.05). No correlation was found between age, length of fasting and use of opioids with the intensity of thirst and discomfort. Conclusion and implication in the clinical practice: Discomfort arising from the attributes of thirst is evidenced as the intensity of thirst increases.

Engineering Approaches to Assessing Hydration Status

Dehydration is a common condition characterized by a decrease in total body water. Acute dehydration can cause physical and cognitive impairment, heat stroke and exhaustion, and, if severe and uncorrected, even death. The health effects of chronic mild dehydration are less well studied with urolithiasis (kidney stones) the only condition consistently associated with it. Aside from infants and those with particular medical conditions, athletes, military personnel, manual workers, and older adults are at particular risk of dehydration due to their physical activity, environmental exposure, and/or challenges in maintaining fluid homeostasis. This review describes the different approaches that have been explored for hydration assessment in adults. These include clinical indicators perceived by the patient or detected by a practitioner and routine laboratory analyses of blood and urine. These techniques have variable accuracy and practicality outside of controlled environments, creating a need for simple, portable, and rapid hydration monitoring devices. We review the wide array of devices proposed for hydration assessment based on optical, electromagnetic, chemical, and acoustical properties of tissue and bodily fluids. However, none of these approaches has yet emerged as a reliable indicator in diverse populations across various settings, motivating efforts to develop new methods of hydration assessment.

National Athletic Trainers' Association Position Statement: Fluid Replacement for the Physically Active

OBJECTIVE

  To present evidence-based recommendations that promote optimized fluid-maintenance practices for physically active individuals.

BACKGROUND

  Both a lack of adequate fluid replacement (hypohydration) and excessive intake (hyperhydration) can compromise athletic performance and increase health risks. Athletes need access to water to prevent hypohydration during physical activity but must be aware of the risks of overdrinking and hyponatremia. Drinking behavior can be modified by education, accessibility, experience, and palatability. This statement updates practical recommendations regarding fluid-replacement strategies for physically active individuals.

RECOMMENDATIONS

  Educate physically active people regarding the benefits of fluid replacement to promote performance and safety and the potential risks of both hypohydration and hyperhydration on health and physical performance. Quantify sweat rates for physically active individuals during exercise in various environments. Work with individuals to develop fluid-replacement practices that promote sufficient but not excessive hydration before, during, and after physical activity.

Am I Drinking Enough? Yes, No, and Maybe

Adequate fluid intake can be dually defined as a volume of fluid (from water, beverages, and food) sufficient to replace water losses and provide for solute excretion. A wide range of fluid intakes are compatible with euhydration, whereby total body water varies narrowly from day to day by 600 to 900 mL (<1% body mass). One measure of fluid intake adequacy involves enough fluid to prevent meaningful body water deficits outside this euhydration range (i.e., dehydration). Another measure of fluid intake adequacy involves enough fluid to balance the renal solute load, which can vary widely inside the euhydration range. The subtle but important distinction between the 2 types of adequacy may explain some of the ambiguity surrounding the efficacy of hydration status markers. Both perspectives of fluid intake adequacy are discussed in detail and a simple tool is reviewed that may help healthy, active, low-risk populations answer the question, "Am I drinking enough?" Key Teaching Points • Adequate fluid intake can be dually defined as a volume of fluid (from water, beverages, and food) sufficient to replace water losses and provide for solute excretion. • Fluid needs can differ greatly among individuals due to variation in the factors that influence both water loss and solute balance; thus, adequacy is consistent with a wide range of fluid intakes and is better gauged using hydration assessment methods. • Adequacy of fluid intake for replacing meaningful water losses (dehydration) can be assessed simply, inexpensively, and with reasonable fidelity among healthy, active, low-risk individuals. • Adequacy of fluid intake for solute excretion per se can also be assessed among individuals but is more difficult to define and less practical to measure.