Comparison between blood and urinary fluid balance indices during dehydrating exercise and the subsequent hypohydration when fluid is not restored

Assessment of exercise-induced dehydration in underhydrated athletes: Which method shows the most promise?

BACKGROUND & AIMS

Athletes are commonly exposed to exercise-induced dehydration. However, the best method to detect dehydration under this circumstance is not clear. This study aimed to analyze pre- and post-dehydration measurements of biomarkers, including saliva osmolality (SOsm), urine osmolality (UOsm), urine-specific gravity (USG), urine color (Ucolor), serum osmolality (SeOsm), serum arginine vasopressin (AVP), serum sodium (Na+), and thirst sensation in underhydrated athletes, using the body mass loss (BML) as the reference method.

METHODS

In this clinical trial (NCT05380089), a total of 38 athletes (17 females) with a regular low water intake (<35 mL/kg/day) were submitted to exercise-induced dehydration with a heat index of 29.8 ± 3.1 °C and an individualized running intensity (80-90% of first ventilatory threshold).

RESULTS

ROC curve analysis revealed significant discriminative abilities of SOsm, with AUC values of 0.76 at 1.5% BML, 0.75 at 1.75% BML, and 0.87 at 2% BML, while Na+ and SeOsm showed the highest AUC of 0.87 and 0.91 at 2% BML, respectively. SOsm showed high sensitivity at 1.5% of BML, while SeOsm and Na+ demonstrated high sensitivity at 2% of BML.

CONCLUSION

This study highlights SOsm as a potential indicator of hydration status across different levels of BML. Additionally, Na+ and SeOsm emerged as accurate dehydration predictors at 1.75% and 2% of BML. Notably, the accuracy of urinary indices and thirst sensation for detecting hydration may be limited.

Hydration, Hyperthermia, Glycogen, and Recovery: Crucial Factors in Exercise Performance-A Systematic Review and Meta-Analysis

Hyperthermia accelerates dehydration and can lead to a glycolysis malfunction. Therefore, to deeply understand the relationship between dehydration and hyperthermia during exercise, as well as in the recovery time, there might be important factors to improve athletic performance. A systematic review was carried out in different databases using the words "hydration" OR "dehydration" AND "glycogen" OR "glycogenesis" OR "glycogenolysis" AND "muscle" OR "muscle metabolism" OR "cardiovascular system" and adding them to the "topic section" in Web of Science, to "Title/Abstract" in PubMed and to "Abstract" in SPORTDiscus. A total of 18 studies were included in the review and 13 in the meta-analysis. The free statistical software Jamovi was used to run the meta-analysis (version 1.6.15). A total sample of 158 people was included in the qualitative analysis, with a mean age of 23.5 years. Ten studies compared muscle glycogen content after hydration vs. remaining dehydrated (SMD -4.77 to 3.71, positive 80% of estimates, \hat{\mu} = 0.79 (95% CI: -0.54 to 2.12), z = 1.17, p = 0.24, Q-test (Q(9) = 66.38, p < 0.0001, tau2 = 4.14, I2 = 91.88%). Four studies examined the effect of temperature on postexercise muscle glycogen content (SMD -3.14 to -0.63, 100% of estimates being negative, \hat{\mu} = -1.52 (95% CI: -2.52 to -0.53), (z = -3.00, p = 0.003, Q-test (Q(3) = 8.40, p = 0.038, tau2 = 0.68, I2 = 66.81%). In conclusion, both hyperthermia and dehydration may contribute to elevated glycogenolysis during exercise and poor glycogen resynthesis during recovery. Although core and muscle hyperthermia are the key factors in glycogen impairments, they are also directly related to dehydration.

Examining the effects of pre-competition rapid weight loss on hydration status and competition performance in elite judo athletes

The prevalence of rapid weight loss (RWL) among martial arts athletes including judo is very high. Many applied RWL strategies could be dangerous to health and even lead to death. Therefore, the International Judo Federation (IJF) introduced changes in the weigh-in rules, changing the official weigh-in for the day before the competition. Thus, the purpose of this study was to examine the impact of the new IJF rules on hydration status and weight loss strategies among professional judo athletes. Seventeen elite judo athletes participated in the study. Body mass and hydration status, were analyzed before the competition. Moreover, competition result and practice of RWL survey were collected. All subjects reached their weight category limits for the competition. RWL resulted in body mass changes (p < 0.001, ηp2 = 0.79) and dehydration among participants (urine osmolality > 700 [mOsmol*kg]-1 and urine specific gravity > 1.020 [g*cm3]-1). However, urine osmolality (p > 0.05, ηp2 = 0.18), as well as urine specific gravity (p > 0.05, ηp2 = 0.16), at subsequent time points of measurement revealed no statistical differences. The prevalence of RWL was 100%, and only 17.6% of the athletes declared that they would compete in a different weight category if the competition would be conducted on the same day of the weigh-in. All judo athletes applied RWL procedures using traditional methods to achieve the required body mass (i.e., increased exercise, reduced fluid, and food intake). Dehydration state was not associated with competitive performance (p > 0.05).

A Portable Biodevice to Monitor Salivary Conductivity for the Rapid Assessment of Fluid Status

The evaluation of fluid status can save adults from life-threatening conditions, but the current methods are invasive or time-consuming. Therefore, we developed a portable device for measuring salivary conductivity. This prospective observational study enrolled 20 volunteers with no history of systemic diseases. Participants were observed for 13 h, including water restriction for 12 h followed by rehydration with 1000 mL water within 1 h. Serum and urine biomarkers for fluid status, thirst scales, and salivary conductivity were collected during dehydration and rehydration. No significant differences in age, body mass index, glycohemoglobin, and estimated glomerular filtration rate were noted between sexes. Salivary conductivity increased after water restriction and decreased after rehydration. Similarly, urine osmolality, urine specific gravity, thirst intensity scales, and body weight followed the same trend and were statistically significant. The angiotensin-converting enzyme and aldosterone levels showed the same trend, without reaching statistical significance. The red blood cell count and hemoglobin concentration also followed the same trend. Analyzing the receiver operating characteristic curves, the area under the curve was 0.707 (95% confidence interval 0.542–0.873, p = 0.025). Using the Youden index, the optimal cutoff determined as 2678.09 μs/cm (sensitivity: 90%, specificity: 55%). This biodevice effectively screened dehydration among healthy adults.

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.

Up in the Air: Evidence of Dehydration Risk and Long-Haul Flight on Athletic Performance

The microclimate of an airline cabin consists of dry, recirculated, and cool air, which is maintained at lower pressure than that found at sea level. Being exposed to this distinctive, encapsulated environment for prolonged durations, together with the short-term chair-rest immobilization that occurs during long-haul flights, can trigger distinct and detrimental reactions to the human body. There is evidence that long-haul flights promote fluid shifts to the lower extremity and induce changes in blood viscosity which may accelerate dehydration, possibly compromising an athlete’s potential for success upon arrival at their destination. Surprisingly, and despite several recent systematic reviews investigating the effects of jet lag and transmeridian travel on human physiology, there has been no systematic effort to address to what extent hypohydration is a (health, performance) risk to travelers embarking on long journeys. This narrative review summarizes the rationale and evidence for why the combination of fluid balance and long-haul flight remains a critically overlooked issue for traveling persons, be it for health, leisure, business, or in a sporting context. Upon review, there are few studies which have been conducted on actual traveling athletes, and those that have provide no real evidence of how the incidence rate, magnitude, or duration of acute dehydration may affect the general health or performance of elite athletes.

Dietary Intake, Hydration Status, and Body Composition of Three Belgian Military Groups

Introduction

Malnutrition, suboptimal hydration, and inadequate body composition can have negative consequences on soldiers’ performance and health. A recent consensus statement concerning “soldiers’ physical performance” points to the scarcity of data in specific military populations. Therefore, the aim of the present study was to assess and compare dietary intake, hydration status, and body composition of three military groups during their specific military training.

Materials and Methods

Eighty-five soldiers (ie, 21 in a qualification course to join the Special Forces [SF], 22 Infantrymen [Chasseurs Ardennais, CA], and 42 Recruits [REs]) participated in this 3- to 4-day study. Body mass was assessed before and after each study period. All soldiers self-reported their dietary intakes, from which energy and macronutrient intakes were calculated. In addition, their morning urine samples were collected daily to assess urine specific gravity (USG) as a measure of hydration status. Fat mass was estimated at the end of the study using bioelectrical impedance analysis.

Results

All groups lost significant amounts of body mass (ie, mean losses ranging between 1.3 and 1.7 kg). Macronutrient intakes were not fully met in respect to the recommendations. Most notably, REs’ fat intake was high (ie, 42.3 [±1.6] energy percent [E%]), while their carbohydrate intake was low (ie, 44.5 [±2.1] E%). Furthermore, saturated fat intakes were high among all groups (ie, group means ranging between 13.6 and 21.4 E%). USG values indicated suboptimal hydration status was prevalent in all groups. Most noteworthy, for SF, only 5.4% of the USG values indicated optimal hydration. The average fat mass (%) for SF, CA, and RE was 11.2 (±3.1), 18.8 (±5.1), and 19.4 (±5.0), respectively.

Conclusion

The present study showed that military men are not always adequately fed nor hydrated. These issues should be resolved by creating nutritional packages, and individual dietary and hydration strategies, all in function of military planning and weather conditions.

Validity of Digital and Manual Refractometers for Measuring Urine Specific Gravity During Field Operations: A Brief Report

INTRODUCTION

Dehydration can have an immediate negative impact on the performance of Soldiers in training or combat environments. Field expedient methods for assessing hydration status may be valuable for service members. Measurement of urine-specific gravity (USG) via refractometer is inexpensive, simple, fast, and a validated indicator of hydration status. Manual (MAN) and digital (DIG) refractometers are commonly used in laboratory settings however, digital (DIG) devices have not been validated in the field against MAN devices. The purpose of this study was to determine the validity and feasibility of using a DIG refractometer to assess USG compared to a MAN refractometer during a military field training exercise.

MATERIALS AND METHODS

Fifty-six military service members provided 672 urine samples during two 10-day field training exercises in central Texas. USG was assessed using a MAN and a DIG refractometer with cutoff value of ≥1.020 indicating hypohydration. The study received a non-human research determination.

RESULTS

The MAN measurements were strongly correlated with the DIG (r = 0.91, p < 0.0001) measurements. Bland-Altman analysis demonstrated agreement between the refractometers. The DIG displayed good sensitivity (93.9%) and specificity (85.8%) compared to the MAN.

CONCLUSION

The DIG refractometer used in this study was reliable and valid compared with a MAN device and was feasible for use in a field environment; however, the DIG refractometer tended to over overestimate hypohydration.

Urine specific gravity as an indicator of dehydration in Olympic combat sport athletes; considerations for research and practice

Urine specific gravity (U_SG) is the most commonly reported biochemical marker used in research and applied settings to detect fluid deficits in athletes, including those participating in combat sports. Despite the popularity of its use, there has been a growing debate regarding the diagnostic accuracy and the applicability of U_SG in characterizing whole-body fluid status and fluctuations. Moreover, recent investigations report universally high prevalence of hypohydration (∼90%) via U_SG assessment in combat sport athletes, often in spite of stable body-mass. Given the widespread use in both research and practice, and its use in a regulatory sense as a 'hydration test' in combat sports as a means to detect dehydration at the time of weigh-in; understanding the limitations and applicability of U_SG assessment is of paramount importance. Inconsistencies in findings of U_SG readings, possibly as a consequence of diverse methodological research approaches and/or overlooked confounding factors, preclude a conclusive position stand within current combat sports research and practice. Thus the primary aim of this paper is to critically review the literature regarding U_SG assessment of hydration status in combat sports research and practice. When taken on balance, the existing literature suggests: the use of laboratory derived benchmarks in applied settings, inconsistent sampling methodologies, the incomplete picture of how various confounding factors affect end-point readings, and the still poorly understood potential of renal adaptation to dehydration in combat athletes; make the utility of hydration assessment via U_SG measurement quite problematic, particularly when diet and training is not controlled.

Reliability of Urinary Dehydration Markers in Elite Youth Boxers

PURPOSE

To determine the reliability and diagnostic accuracy of noninvasive urinary dehydration markers in field-based settings on a day-to-day basis in elite adolescent amateur boxers.

METHODS

Sixty-nine urine samples were collected daily from 23 athletes (17.3 ± 1.9 y) during their weight-stable phase and analyzed by field and laboratory measures of hydration status. Urine osmolality (U_OSM), urine specific gravity (U_SG), total protein content (T_PC), and body-mass stability were evaluated to determine fluid balance and hydration status. Overall macronutrient and water intake were determined using dietary records. According to their anthropometric characteristics, athletes were assigned into 2 groups: lightweight (L_WB) and heavyweight (H_WB) boxers.

RESULTS

Data presented on U_OSM demonstrated a uniform increment by 11.2% ± 12.8% (L_WB) and 19.9% ± 22.7% (H_WB) (P < .001) over the course of the study, even during the weight-stable phase (body mass, ICC = .99) and ad libitum fluid intake (42 ± 4 mL · kg^-1 · d^-1). The intraclass correlation coefficients (ICCs) ranged from .52 to .55 for U_SG and .38 to .52 for U_OSM, further indicating inconsistency of the urinary dehydration markers. Poor correlations were found between U_SG and T_PC metabolites (r = .27, P = .211).

CONCLUSIONS

Urinary dehydration markers (both U_SG and U_OSM) exhibit high variability and seem to be unreliable diagnostic tools to track actual body-weight loss in real-life settings. The ad libitum fluid intake was apparently inadequate to match acute fluid loss during and after intense preparation. The applicability of a single-time-point hydration-status assessment concept may preclude accurate assessment of actual body-weight deficits in youth boxers.

Evaluation and review of body fluids saliva, sweat and tear compared to biochemical hydration assessment markers within blood and urine

Evaluating and testing hydration status is increasingly requested by rehabilitation, sport, military and performance-related activities. Besides commonly used biochemical hydration assessment markers within blood and urine, which have their advantages and limitations in collection and evaluating hydration status, there are other potential markers present within saliva, sweat or tear. This literature review focuses on body fluids saliva, sweat and tear compared to blood and urine regarding practicality and hydration status influenced by fluid restriction and/or physical activity. The selected articles included healthy subjects, biochemical hydration assessment markers and a well-described (de)hydration procedure. The included studies (n=16) revealed that the setting and the method of collecting respectively accessing body fluids are particularly important aspects to choose the optimal hydration marker. To obtain a sample of saliva is one of the simplest ways to collect body fluids. During exercise and heat exposures, saliva composition might be an effective index but seems to be highly variable. The collection of sweat is a more extensive and time-consuming technique making it more difficult to evaluate dehydration and to make a statement about the hydration status at a particular time. The collection procedure of tear fluid is easy to access and causes very little discomfort to the subject. Tear osmolarity increases with dehydration in parallel to alterations in plasma osmolality and urine-specific gravity. But at the individual level, its sensitivity has to be further determined.

Tear osmolarity is sensitive to exercise-induced fluid loss but is not associated with common hydration measures in a field setting

This investigation (i) examined changes in tear osmolarity in response to fluid loss that occurs with exercise in a field setting, and (ii) compared tear osmolarity with common field and laboratory hydration measures.  Sixty-three participants [age 27.8 ± 8.4 years, body mass 72.15 ± 10.61 kg] completed a self-paced 10 km run outside on a predetermined course. Body mass, tear fluid, venous blood and urine samples were collected immediately before and after exercise.  Significant (p < 0.001) reductions in body mass (1.71 ± 0.44%) and increases in tear osmolarity (8 ± 15 mOsm.L^-1), plasma osmolality (7 ± 8 mOsm.kg^-1), and urine specific gravity (0.0014 ± 0.0042 g.mL^-1; p = 0.008) were observed following exercise. Pre- to post-exercise change in tear osmolarity was not significantly correlated (all p > 0.05) with plasma osmolality (r_s = 0.24), urine osmolality (r_s = 0.14), urine specific gravity (r_s = 0.13) or relative body mass loss (r = 0.20).  Tear osmolarity is responsive to exercise-induced fluid loss but does not correlate with the changes observed using other common measures of hydration status in the field setting. Practitioners shouldn't directly compare or replace other common hydration measures with tear osmolarity in the field.

ABBREVIATIONS

BML: Body Mass Loss; CV: Coefficient of Variation; P_osm: Plasma osmolality; SD: Standard Deviation; T_osm: Tear Osmolarity; U_osm: Urine Osmolality; USG: Urine Specific Gravity; WBGT: Wet bulb globe thermometer.

A comparative evaluation of two decompression procedures for technical diving using inflammatory responses: compartmental versus ratio deco

INTRODUCTION

The aim of this study was to compare two decompression procedures commonly adopted by technical divers: the ZH-L16 algorithm modified by 30/85 gradient factors (compartmental decompression model, CDM) versus the 'ratio decompression strategy' (RDS). The comparison was based on an analysis of changes in diver circulating inflammatory profiles caused by decompression from a single dive.

METHODS

Fifty-one technical divers performed a single trimix dive to 50 metres' sea water (msw) for 25 minutes followed by enriched air (EAN50) and oxygen decompression. Twenty-three divers decompressed according to a CDM schedule and 28 divers decompressed according to a RDS schedule. Peripheral blood for detection of inflammatory markers was collected before and 90 min after diving. Venous gas emboli were measured 30 min after diving using 2D echocardiography. Matched groups of 23 recreational divers (dive to 30 msw; 25 min) and 25 swimmers were also enrolled as control groups to assess the effects of decompression from a standard air dive or of exercise alone on the inflammatory profile.

RESULTS

Echocardiography at the single 30 min observation post dive showed no significant differences between the two decompression procedures. Divers adopting the RDS showed a worsening of post-dive inflammatory profile compared to the CDM group, with significant increases in circulating chemokines CCL2 (P = 0.001) and CCL5 (P = 0.006) levels. There was no increase in chemokines following the CDM decompression. The air scuba group also showed a statistically significant increase in CCL2 (P < 0.001) and CCL5 (P = 0.003) levels post dive. No cases of decompression sickness occurred.

CONCLUSION

The ratio deco strategy did not confer any benefit in terms of bubbles but showed the disadvantage of increased decompression-associated secretion of inflammatory chemokines involved in the development of vascular damage.

Validity of Urine Specific Gravity When Compared With Plasma Osmolality as a Measure of Hydration Status in Male and Female NCAA Collegiate Athletes

Sommerfield, LM, McAnulty, SR, McBride, JM, Zwetsloot, JJ, Austin, MD, Mehlhorn, JD, Calhoun, MC, Young, JO, Haines, TL, and Utter, AC. Validity of urine specific gravity when compared with plasma osmolality as a measure of hydration status in male and female NCAA collegiate athletes. J Strength Cond Res 30(8): 2219-2225, 2016-The purpose of this study was to evaluate the response of urine specific gravity (Usg) and urine osmolality (Uosm) when compared with plasma osmolality (Posm) from euhydration to 3% dehydration and then a 2-hour rehydration period in male and female collegiate athletes. Fifty-six National Collegiate Athletic Association (NCAA) wrestlers (mean ± SEM); height 1.75 ± 0.01 m, age 19.3 ± 0.2 years, and body mass (BM) 78.1 ± 1.8 kg and 26 NCAA women's soccer athletes; height 1.64 ± 0.01 m, age 19.8 ± 0.3 years, and BM 62.2 ± 1.2 kg were evaluated. Hydration status was obtained by measuring changes in Posm, Uosm, Usg, and BM. Male and female subjects dehydrated to achieve an average BM loss of 2.9 ± 0.09% and 1.9 ± 0.03%, respectively. Using the medical diagnostic decision model, the sensitivity of Usg was high in both the hydrated and dehydrated state for males (92%) and females (80%). However, the specificity of Usg was low in both the hydrated and dehydrated states for males (10 and 6%, respectively) and females (29 and 40%, respectively). No significant correlations were found between Usg and Posm during either the hydrated or dehydrated state for males or females. Based on these results, the use of Usg as a field measure of hydration status in male and female collegiate athletes should be used with caution. Considering that athletes deal with hydration status on a regular basis, the reported low specificity of Usg suggests that athletes could be incorrectly classified leading to the unnecessary loss of competition.

Validity of hydration non-invasive indices during the weightcutting and official weigh-in for Olympic combat sports

Background

In Olympic combat sports, weight cutting is a common practice aimed to take advantage of competing in weight divisions below the athlete's normal weight. Fluid and food restriction in combination with dehydration (sauna and/or exercise induced profuse sweating) are common weight cut methods. However, the resultant hypohydration could adversely affect health and performance outcomes.

Purpose

The aim of this study is to determine which of the routinely used non-invasive measures of dehydration best track urine osmolality, the gold standard non-invasive test.

Method

Immediately prior to the official weigh-in of three National Championships, the hydration status of 345 athletes of Olympic combat sports (i.e., taekwondo, boxing and wrestling) was determined using five separate techniques: i) urine osmolality (U_OSM), ii) urine specific gravity (U_SG), iii) urine color (U_COL), iv) bioelectrical impedance analysis (BIA), and v) thirst perception scale (TPS). All techniques were correlated with U_OSM divided into three groups: euhydrated (G₁; U_OSM 250–700 mOsm·kg H₂O⁻¹), dehydrated (G₂; U_OSM 701–1080 mOsm·kg H₂O⁻¹), and severely dehydrated (G₃; U_OSM 1081–1500 mOsm·kg H₂O⁻¹).

Results

We found a positive high correlation between the U_OSM and U_SG (r = 0.89: p = 0.000), although this relationship lost strength as dehydration increased (G₁ r = 0.92; G₂ r = 0.73; and G₃ r = 0.65; p = 0.000). U_COL showed a moderate although significant correlation when considering the whole sample (r = 0.743: p = 0.000) and G₁ (r = 0.702: p = 0.000) but low correlation for the two dehydrated groups (r = 0.498–0.398). TPS and BIA showed very low correlation sizes for all groups assessed.

Conclusion

In a wide range of pre-competitive hydration status (U_OSM 250–1500 mOsm·kg H₂O⁻¹), U_SG is highly associated with U_OSM while being a more affordable and easy to use technique. U_COL is a suitable tool when U_SG is not available. However, BIA or TPS are not sensitive enough to detect hypohydration at official weight-in before an Olympic combat championship.