Hydration Status and Fluid Needs of Division I Female Collegiate Athletes Exercising Indoors and Outdoors

Validity of combined hydration self-assessment measurements to estimate a low vs. high urine concentration in a small sample of (tactical) athletes

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.

24 h Hydration profile of collegiate soccer players training once versus twice per day in the heat

This study examined 24-h hydration parameters among collegiate, male soccer players (n = 17) during twice (X2) and once (X1) per day practice schedules in the heat. Urine specific gravity (USG) and body mass were measured before morning practices, afternoon practice (X2)/team meeting (X1), and the next morning practices. Fluid intake, sweat losses, and urinary losses were assessed during each 24-h window. Pre-practice body mass or USG did not differ among the timepoints. Sweat losses differed among all practices (p < 0.05) and averaged approximately 2.181±0.693 (X2AM) 1.710±0.474 (X2PM), and 3.361±0.956 L (X1AM), but players averaged replacing >50% of sweat losses with fluid intake every practice. Fluid intake during and between practices from practice 1 to the afternoon practice for X2 resulted in a positive fluid balance for X2 (+0.446±0.916 L). However, higher sweat loss during the initial morning practice and lower relative fluid intake prior to the afternoon team meeting the following morning resulted in a negative fluid balance (-0.304±0.675 L; p < 0.05: Cohen's d = 0.94) over the same time period for X1. By the start of the next morning practice sessions, both X1 (+0.664±1.051 L) and X2 (+0.446±0.916 L) were in positive fluid balance, respectively. Ample fluid consumption opportunities, scaled down practice intensities during X2, and potentially intentional greater relative fluid intake during X2 training resulted in no difference in fluid shift versus an X1 schedule before the start of practices. The majority of players maintained fluid balance drinking ad libitum regardless of practice schedule.

Effect of increased water intake on uropathogenic bacterial activity of underhydrated menstruating young adult women: A randomized crossover trial

Background: Females are prone to urinary tract infections (UTIs) due to estrogen fluctuations affecting vaginal flora. While menstruating, increased fluid consumption to support urination frequency and void volume may be important, as the urethra and urinary tract are more predisposed to bacteria, particularly UTI pathogens. Aim: This study aimed to investigate the impact of hydration on urinary tract health during menstruation among underhydrated premenopausal women. Methods: Thirteen females participated in a 60-day 2 × 2 randomized crossover trial to evaluate the effectiveness of consuming ≥2.2 L of total beverage fluid intake, with 1.9 L being water, (intervention, INT) and maintaining habitual fluid intake (control, CON) on two subsequent menses. Participants completed fluid and urination diaries at days 2 and 5 after the onset of bleeding (day 1) to determine the fluid amount consumed and urination frequency. Urine concentration was assessed in afternoon (days 2 and 5) and uropathogenic bacterial activity in first-morning (days 3 and 6) urinations. General linear models assessed differences in bacterial and hydration outcomes. Results: The intervention led to a 62% mean total fluid increase, INT 3.0 ± 1.1 L and CON 1.9 ± 0.9 L, p < 0.001, η 2  = 0.459. Urination frequency was greater and urine concentration less in the INT to CON, all ps < 0.05, η 2 range = 0.023-0.019. Only four cultures detected uropathogenic bacteria, with no patterns between conditions or days, making it difficult to determine the intervention's effectiveness. Conclusion: Fluid intake increased, and hydration status improved. No differences in uropathogenic bacterial activity were seen between the hydration and control conditions.

Validity of Urine Color Scoring Using Different Light Conditions and Scoring Techniques to Assess Urine Concentration

CONTEXT

Urine color (Uc) is used to asses urine concentration when laboratory techniques are not feasible.

OBJECTIVE

To compare the accuracy of Uc scoring using 4 light conditions and 2 scoring techniques with a 7-color Uc chart. Additionally, to assess the results' generalizability, a subsample was compared with scores obtained from fresh samples.

DESIGN

Descriptive laboratory study.

SAMPLES

A total of 178 previously frozen urine samples were scored, and 78 samples were compared with their own fresh outcomes.

MAIN OUTCOME MEASURE(S)

Urine color and accuracy for classifying urine samples were calculated using receiver operating characteristics analysis, allowing us to compare the diagnostic capacity against a 1.020 urine specific gravity cutoff and defining optimal Uc cutoff value.

RESULTS

Urine color was different among light conditions (P < .01), with the highest accuracy (80.3%) of correct classifications of low or high urine concentrations occurring at the brightest light condition. Lower light intensity scored 1.5 to 2 shades darker on the 7-color Uc scale than bright conditions (P < .001), but no further practical differences in accuracy occurred between scoring techniques. Frozen was 0.5 to 1 shade darker than freshly measured Uc (P < .004), but the values were moderately correlated (r = 0.64). A Bland-Altman plot showed that reporting bias mainly affected darker Uc without affecting the diagnostic ability of the method.

CONCLUSIONS

Urine color scoring, accuracy, and Uc cutoff values were affected by lighting condition but not by scoring technique, with greater accuracy and a 1-shade-lower Uc cutoff value at the brightest light (ie, light-emitting diode flashlight).

Athletes' Self-Assessment of Urine Color Using Two Color Charts to Determine Urine Concentration

Our objective was to determine self-reported accuracy of an athletic population using two different urine color (Uc) charts (8-color vs. 7-color Uc chart). After approval by the Institutional Review Board, members of an athletic population (n = 189, 20 (19–22) year old student- or tactical athletes and coaches, with n = 99 males and n = 90 females) scored their Uc using two charts. To determine the diagnostic value of Uc, results were compared with urine concentration (osmolality and urine specific gravity, USG). Uc was scored slightly darker with the 8-color vs. 7-color Uc chart (2.2 ± 1.2 vs. 2.0 ± 1.2, respectively, p < 0.001), with a moderate correlation between charts (r = 0.76, 95% CI: 0.69–0.81). Bland-Altman analysis showed a weak reporting bias (r = 0.15, p = 0.04). The area under the curve for correct urine sample classification ranged between 0.74 and 0.86. Higher accuracy for both methods was found when Uc scores were compared to USG over osmolality, indicated by 4.8–14.8% range in difference between methods. The optimal Uc cut-off value to assess a low vs. a high urine concentration for both Uc charts varied in this study between 1 and ≤2 while accuracy for charts was similar up to 77% when compared to USG.

Reliability of Three Urine Specific Gravity Meters Measuring Brix and Urine Solutions at Different Temperatures

CONTEXT

The measurement of urine specific gravity should be performed at room temperature (20 °C) but sample temperature is not always taken in consideration.

OBJECTIVE

Evaluate the effect of sample temperature on the measurement accuracy of a digital (DIG) and optical (MAN) refractometer and a hydrometer (HYD).

DESIGN

Quantitative comparison between measurement outcomes for a reference solution (sucrose, degrees Brix) and fresh collected urine samples.

SAMPLES

Experiment 1 used a 24 Brix (°Bx) samples and experiment 2 used 33 fresh urine samples.

MAIN OUTCOME MEASURE

Urine specific gravity (USG).

RESULTS

Experiment 1 showed DIG and MAN did not differ from reference, but HYD reported lower or inconsistent values compared to Bx, while highly correlating with Bx solutions (r: > 0.89). The overall diagnostic ability of elevated USG (≥ 1.020; ≥ 1.025; ≥ 1.030) was high for all tools (AUC > 0.92). Misclassification of samples increased from 0 to 2 at 1.020 to 1 to 3 samples at cutoff 1.025 and 1.030 USG. Bland-Altman analysis showed DIG 5 °C underreports slightly without reporting bias (r: -0.344, P = 0.13); all other plots for DIG, MAN, and HYD showed considerably larger underreporting at higher concentrations (r ranging from -0.21 to -0.97 with P > .02) at all temperatures. The outcomes of experiment 2 using DIG 20°C as standard, showed only negligible differences between DIG and MAN at all temperatures, but larger differences using HYD.

CONCLUSIONS

All tools showed reporting bias when compared to °Bx solutions which can impact classification of low and high urine concentration at higher USG cutoff values, especially at a sample temperature of 37 °C.

Effects of Field Position on Fluid Balance and Electrolyte Losses in Collegiate Women's Soccer Players

Background and objectives: Research investigating hydration strategies specialized for women’s soccer players is limited, despite the growth in the sport. The purpose of this study was to determine the effects of fluid balance and electrolyte losses in collegiate women’s soccer players. Materials and Methods: Eighteen NCAA Division I women’s soccer players were recruited (age: 19.2 ± 1.0 yr; weight: 68.5 ± 9.0 kg, and height: 168.4 ± 6.7 cm; mean ± SD), including: 3 forwards (FW), 7 mid-fielders (MD), 5 defenders (DF), and 3 goalkeepers (GK). Players practiced outdoor during spring off-season training camp for a total 14 practices (WBGT: 18.3 ± 3.1 °C). The main outcome measures included body mass change (BMC), sweat rate, urine and sweat electrolyte concentrations, and fluid intake. Results: Results were analyzed for comparison between low (LOW; 16.2 ± 2.6° C, n = 7) and moderate risk environments for hyperthermia (MOD; 20.5 ± 1.5 °C, n = 7) as well as by field position. The majority (54%) of players were in a hypohydrated state prior to practice. Overall, 26.7% of players had a %BMC greater than 0%, 71.4% of players had a %BMC less than −2%, and 1.9% of players had a %BMC greater than −2% (all MD position). Mean %BMC and sweat rate in all environmental conditions were −0.4 ± 0.4 kg (−0.5 ± 0.6% body mass) and 1.03 ± 0.21 mg·cm⁻²·min⁻¹, respectively. In the MOD environment, players exhibited a greater sweat rate (1.07 ± 0.22 mg·cm⁻²·min⁻¹) compared to LOW (0.99 ± 0.22 mg·cm⁻²·min⁻¹; p = 0.02). By position, DF had a greater total fluid intake and a lower %BMC compared to FW, MD, and GK (all p < 0.001). FW had a greater sweat sodium (Na+) (51.4 ± 9.8 mmol·L⁻¹), whereas GK had the lowest sweat sodium (Na+) (30.9 ± 3.9 mmol·L⁻¹). Conclusions: Hydration strategies should target pre-practice to ensure players are adequately hydrated. Environments deemed to be of moderate risk of hyperthermia significantly elevated the sweat rate but did not influence fluid intake and hydration status compared to low-risk environments. Given the differences in fluid balance and sweat responses, recommendations should be issued relative to soccer position.