Sex difference in fluid balance responses during prolonged exercise

No hyponatremia despite continuous plasma sodium decline in female runners during a seven stage ultramarathon

The role of sodium supplements and sex in the occurrence of exercise-associated hyponatremia (EAH) remains controversial. This study investigated hydration status in ultrarunners (19 males and 9 females) who completed seven marathons over seven consecutive days. Due to the limited number of female participants, no statistical comparison between sexes was performed. Plasma sodium concentration ([Na+]) and multiple hydration markers were assessed before, during, and after the race. Reported sodium supplement consumption showed no association with plasma [Na+]. An overall decline in plasma [Na+] was observed in females (regression slope = -1.278, p = 0.02) across the event, whereas no significant change was detected in males (slope = -0.325, p = 0.57). Additionally, no significant associations were found between plasma [Na+] and other monitored variables, including sodium supplement intake, pre-race hydration strategy, body mass, total body water, plasma osmolality, hematocrit, hemoglobin, urine specific gravity, urinary [Na+], thirst rating, or fluid intake reported pre-, during, and post-stage. No cases of symptomatic or asymptomatic hyponatremia were identified, suggesting that total fluid and sodium intake were adequate to maintain fluid-electrolyte balance and prevent EAH in both sexes.

International society of sports nutrition position stand: nutritional concerns of the female athlete

Based on a comprehensive review and critical analysis of the literature regarding the nutritional concerns of female athletes, conducted by experts in the field and selected members of the International Society of Sports Nutrition (ISSN), the following conclusions represent the official Position of the Society: 1. Female athletes have unique and unpredictable hormone profiles, which influence their physiology and nutritional needs across their lifespan. To understand how perturbations in these hormones affect the individual, we recommend that female athletes of reproductive age should track their hormonal status (natural, hormone driven) against training and recovery to determine their individual patterns and needs and peri and post-menopausal athletes should track against training and recovery metrics to determine the individuals' unique patterns. 2. The primary nutritional consideration for all athletes, and in particular, female athletes, should be achieving adequate energy intake to meet their energy requirements and to achieve an optimal energy availability (EA); with a focus on the timing of meals in relation to exercise to improve training adaptations, performance, and athlete health. 3. Significant sex differences and sex hormone influences on carbohydrate and lipid metabolism are apparent, therefore we recommend first ensuring athletes meet their carbohydrate needs across all phases of the menstrual cycle. Secondly, tailoring carbohydrate intake to hormonal status with an emphasis on greater carbohydrate intake and availability during the active pill weeks of oral contraceptive users and during the luteal phase of the menstrual cycle where there is a greater effect of sex hormone suppression on gluconogenesis output during exercise. 4. Based upon the limited research available, we recommend that pre-menopausal, eumenorrheic, and oral contraceptives using female athletes should aim to consume a source of high-quality protein as close to beginning and/or after completion of exercise as possible to reduce exercise-induced amino acid oxidative losses and initiate muscle protein remodeling and repair at a dose of 0.32-0.38 g·kg-1. For eumenorrheic women, ingestion during the luteal phase should aim for the upper end of the range due to the catabolic actions of progesterone and greater need for amino acids. 5. Close to the beginning and/or after completion of exercise, peri- and post-menopausal athletes should aim for a bolus of high EAA-containing (~10 g) intact protein sources or supplements to overcome anabolic resistance. 6. Daily protein intake should fall within the mid- to upper ranges of current sport nutrition guidelines (1.4-2.2 g·kg-1·day-1) for women at all stages of menstrual function (pre-, peri-, post-menopausal, and contraceptive users) with protein doses evenly distributed, every 3-4 h, across the day. Eumenorrheic athletes in the luteal phase and peri/post-menopausal athletes, regardless of sport, should aim for the upper end of the range. 7. Female sex hormones affect fluid dynamics and electrolyte handling. A greater predisposition to hyponatremia occurs in times of elevated progesterone, and in menopausal women, who are slower to excrete water. Additionally, females have less absolute and relative fluid available to lose via sweating than males, making the physiological consequences of fluid loss more severe, particularly in the luteal phase. 8. Evidence for sex-specific supplementation is lacking due to the paucity of female-specific research and any differential effects in females. Caffeine, iron, and creatine have the most evidence for use in females. Both iron and creatine are highly efficacious for female athletes. Creatine supplementation of 3 to 5 g per day is recommended for the mechanistic support of creatine supplementation with regard to muscle protein kinetics, growth factors, satellite cells, myogenic transcription factors, glycogen and calcium regulation, oxidative stress, and inflammation. Post-menopausal females benefit from bone health, mental health, and skeletal muscle size and function when consuming higher doses of creatine (0.3 g·kg-1·d-1). 9. To foster and promote high-quality research investigations involving female athletes, researchers are first encouraged to stop excluding females unless the primary endpoints are directly influenced by sex-specific mechanisms. In all investigative scenarios, researchers across the globe are encouraged to inquire and report upon more detailed information surrounding the athlete's hormonal status, including menstrual status (days since menses, length of period, duration of cycle, etc.) and/or hormonal contraceptive details and/or menopausal status.

The Effect of Starting Blood Glucose Levels on Serum Electrolyte Concentrations during and after Exercise in Type 1 Diabetes

Fear of hypoglycemia is a major exercise barrier for people with type 1 diabetes (PWT1D). Consequently, although guidelines recommend starting exercise with blood glucose (BG) concentration at 7-10 mmol/L, PWT1D often start higher, potentially affecting hydration and serum electrolyte concentrations. To test this, we examined serum and urine electrolyte concentrations during aerobic exercise (cycling 45 min at 60%VO₂peak) in 12 PWT1D (10F/2M, mean ± SEM: age 29 ± 2.3 years, VO₂peak 37.9 ± 2.2 mL·kg^-1·min^-1) with starting BG levels: 8-10 (MOD), and 12-14 (HI) mmol/L. Age, sex, and fitness-matched controls without diabetes (CON) completed one exercise session with BG in the normal physiological range. Serum glucose was significantly higher during exercise and recovery in HI versus MOD (p = 0.0002 and p < 0.0001, respectively) and in MOD versus CON (p < 0.0001). During exercise and recovery, MOD and HI were not significantly different in serum insulin (p = 0.59 and p = 0.63), sodium (p = 0.058 and p = 0.08), potassium (p = 0.17 and p = 0.16), calcium (p = 0.75 and 0.19), and magnesium p = 0.24 and p = 0.09). Our findings suggest that exercise of moderate intensity and duration with higher BG levels may not pose an immediate risk to hydration or serum electrolyte concentrations for PWT1D.

Exercise-Associated Hyponatremia in Marathon Runners

Exercise-associated hyponatremia (EAH) was first described as water intoxication by Noakes et al. in 1985 and has become an important topic linked to several pathological conditions. However, despite progressive research, neurological disorders and even deaths due to hyponatremic encephalopathy continue to occur. Therefore, and due to the growing popularity of exercise-associated hyponatremia, this topic is of great importance for marathon runners and all professionals involved in runners' training (e.g., coaches, medical staff, nutritionists, and trainers). The present narrative review sought to evaluate the prevalence of EAH among marathon runners and to identify associated etiological and risk factors. Furthermore, the aim was to derive preventive and therapeutic action plans for marathon runners based on current evidence. The search was conducted on PubMed, Scopus and Google Scholar using a predefined search algorithm by aggregating multiple terms (marathon run; exercise; sport; EAH; electrolyte disorder; fluid balance; dehydration; sodium concentration; hyponatremia). By this criterion, 135 articles were considered for the present study. Our results revealed that a complex interaction of different factors could cause EAH, which can be differentiated into event-related (high temperatures) and person-related (female sex) risk factors. There is variation in the reported prevalence of EAH, and two major studies indicated an incidence ranging from 7 to 15% for symptomatic and asymptomatic EAH. Athletes and coaches must be aware of EAH and its related problems and take appropriate measures for both training and competition. Coaches need to educate their athletes about the early symptoms of EAH to intervene at the earliest possible stage. In addition, individual hydration strategies need to be developed for the daily training routine, ideally in regard to sweat rate and salt losses via sweat. Future studies need to investigate the correlation between the risk factors of EAH and specific subgroups of marathon runners.

Heat tolerance during uncompensable heat stress in men and women wearing firefighter personal protective equipment

Firefighters run a risk of heat strain during occupational tasks. The number of female firefighters has been increasing, but research relevant to this group is still scarce. We aimed to investigate whether there are any sex differences in heat tolerance or physiological responses during uncompensable heat stress while wearing firefighter personal protective equipment. Twelve female (28 ± 7 years, 66 ± 5 kg, 51.7 ± 4.7 mL kg^-1 min^-1) and 12 male (27 ± 7 years, 83 ± 8 kg, 58.8 ± 7.5 mL kg^-1 min^-1) participants performed walking (maximum of 60 min) at 6W·kg^-1, 40 °C, and 14% relative humidity. No differences were observed between groups in heat tolerance, rectal temperature, heart rate, percent body mass loss, thermal sensation, and rate of perceived exertion. Thus, when personnel are selected using gender-neutral physical employment standards, sex is not an independent factor influencing heat tolerance when wearing firefighter personal protective equipment during uncompensable heat stress.

Edema-like symptoms are common in ultra-distance cyclists and driven by overdrinking, use of analgesics and female sex - a study of 919 athletes

Background

Ultra-endurance cyclists regularly report various extents of bodily decline during long-distance bicycle rides, including potential kidney function-related symptoms such as swelling of body parts and urine changes. This study aimed to assess the prevalence of these symptoms in a representative cohort of ultra-endurance cyclists and shed light on potential predictors related to the ride, the rider and the rider’s behavior.

Methods

Between November 26 and December 14, 2020, 1350 people participated in an online survey investigating potential kidney-related symptoms of ultra-distance cycling. Frequency and severity of edema-like (“swelling”) symptoms and perceived changes in urine output, concentration and quality were associated with ride-related factors, demographic parameters and rider behavior-related variables.

Results

A total of 919 participants met the predefined inclusion criteria. The majority (N = 603, 65.6%) stated that they suffered from at least one potential kidney function-related symptom, out of which 498 (54.2%) stated one or more edema-like (“swelling”) symptoms. In correlational and multiple regression analyses, female sex, intake of analgesics and drinking strategies correlated with swelling symptoms. Further analyses indicated that drinking due to thirst and/or drinking adapted to ambient sweating and temperature negatively correlated with swelling symptoms, whereas “drinking as much as possible” enhanced these. Intake of analgesics was moderately positively correlated with swelling symptoms.

Conclusions

According to our survey, edema-like symptoms occur in the majority of ultra-distance cyclists and female sex, drinking strategy and intake of analgesic drugs are major predictors thereof. Studies are needed to investigate the underlying pathophysiological processes of such symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12970-021-00470-0.

Dehydration and Rapid Weight Gain Between Weigh-in and Competition in Judo Athletes: The Differences between Women and Men

This study aimed to investigate the sex differences in short-term weight change and hydration status in judo athletes. Thirty-five men and 15 women judo athletes voluntarily participated in this descriptive and repeated measures design study. Body mass, urine-specific gravity (USG), and body composition of the athletes were measured at the official weigh-in and the competition day's morning. Body mass of the athletes increased during recovery time between official weigh-in and before the competition (time factor; F_1-48 = 71.81, p < 0.001), this increase was higher in men athletes compared to women athletes (time-sex interaction; F_1-48 = 6.56, p = 0.01). With RWG, USG values of the women and men athletes decreased (time factor; F_1-48 = 8.53, p = 0.005). However, most of the athletes were still in significant or serious dehydration state. Unchanged values of total body water rates (TBW) supported dehydration in athletes before the competition (time factor, F_1-48 = 2.9, p = 0.091; time-sex interaction; F_1-48= 2.4, p = 0.122). The findings of the study indicated that RWG was higher in men athletes compared to women athletes, but hydration status was not affected by sex factor.Notwithstanding 15 hours of recovery between official weigh-in and the start of the competition, judo athletes were still in dehydrated state despite remaining within the limit set for RWG.

Sauna dehydration as a new physiological challenge model for intestinal barrier function

The intestinal barrier plays a crucial role in maintaining gut health, and an increased permeability has been linked to several intestinal and extra-intestinal disorders. There is an increasing demand for interventions aimed at strengthening this barrier and for in vivo challenge models to assess their efficiency. This study investigated the effect of sauna-induced dehydration on intestinal barrier function (clinicaltrials.gov: NCT03620825). Twenty healthy subjects underwent three conditions in random order: (1) Sauna dehydration (loss of 3% body weight), (2) non-steroidal anti-inflammatory drug (NSAID) intake, (3) negative control. Intestinal permeability was assessed by a multi-sugar urinary recovery test, while intestinal damage, bacterial translocation and cytokines were assessed by plasma markers. The sauna dehydration protocol resulted in an increase in gastroduodenal and small intestinal permeability. Presumably, this increase occurred without substantial damage to the enterocytes as plasma intestinal fatty acid-binding protein (I-FABP) and liver fatty acid-binding protein (L-FABP) were not affected. In addition, we observed significant increases in levels of lipopolysaccharide-binding protein (LBP), IL-6 and IL-8, while sCD14, IL-10, IFN-ɣ and TNF-α were not affected. These results suggest that sauna dehydration increased intestinal permeability and could be applied as a new physiological in vivo challenge model for intestinal barrier function.

Total Fasting and Dehydration in the Operating Room: How Can Surgeons Survive and Thrive?

OBJECTIVES

Hydration and nutrition are critical to achieving optimal performance. This study aimed to assess the impact of limited oral intake in the operating room environment on surgical resident health, well-being, and performance.

DESIGN

Electronic survey was sent to 94 surgical trainees at our institution in 2020. Chi-square analyses were performed to assess for differences in survey responses by sex.

SETTING

A single tertiary-care institution.

PARTICIPANTS

Surveys were sent to surgical residents and fellows in general surgery, neurosurgery, and orthopedic surgery. Seventy-nine (80%) of the 94 residents and fellows responded.

RESULTS

Of the 79 responses, most trainees (79%) experienced dehydration within 6 hours of operating. Forty-four (56%) reported no fluid intake for greater than 6 hours on average, and 39 (49%) reported that they frequently had difficulty rehydrating in between cases. Most of the respondents (70%) frequently experienced symptoms of dehydration, including orthostasis, headache, and constipation. Fifty-six (71%) believed that dehydration frequently affected their performance. Compared to men, women were more likely to feel dehydrated within 4 hours of operating (58% vs. 25%, p = 0.005). Women were also more likely to have difficulty rehydrating in between cases (75% vs. 38%, p = 0.0026), experience symptoms of dehydration (92% vs. 60%, p = 0.0049), and report that dehydration affects surgical performance (88% vs. 64%, p = 0.0318).

CONCLUSIONS

Prolonged fasting and dehydration are common issues that may negatively impact performance and wellbeing of surgical trainees. Also, dehydration may affect men and women differently.

The Effects of Biological Sex on Sepsis Treatments in Animal Models: A Systematic Review and a Narrative Elaboration on Sex- and Gender-Dependent Differences in Sepsis

Preclinical studies provide an opportunity to evaluate the relationship between sex and sepsis, and investigate underlying mechanisms in a controlled experimental environment. The objective of our systematic review was to assess the impact of biological sex on treatment response to fluid and antibiotic therapy in animal models of sepsis. Furthermore, we provide a narrative elaboration of sex-dependent differences in preclinical models of sepsis.

DATA SOURCES

MEDLINE and Embase were searched from inception to March 16, 2020.

STUDY SELECTION

All studies reporting sex-stratified data comparing antibiotics and/or fluid resuscitation with a placebo or no treatment arm in an in vivo model of sepsis were included.

DATA EXTRACTION

Outcomes of interest were mortality (primary) and organ dysfunction (secondary). Risk of bias was assessed. Study selection and data extraction were conducted independently and in duplicate.

DATA SYNTHESIS

The systematic search returned 2,649 unique studies, and two met inclusion criteria. Both studies used cecal ligation and puncture models with imipenem/cilastatin antibiotics. No eligible studies investigated fluids. In one study, antibiotic therapy significantly reduced mortality in male, but not female, animals. The other study reported no sex differences in organ dysfunction. Both studies were deemed to be at a high overall risk of bias.

CONCLUSIONS

There is a remarkable and concerning paucity of data investigating sex-dependent differences in fluid and antibiotic therapy for the treatment of sepsis in animal models. This may reflect poor awareness of the importance of investigating sex-dependent differences. Our discussion therefore expands on general concepts of sex and gender in biomedical research and sex-dependent differences in key areas of sepsis research such as the cardiovascular system, immunometabolism, the microbiome, and epigenetics. Finally, we discuss current clinical knowledge, the potential for reverse translation, and directions for future studies.

REGISTRATION

PROSPERO CRD42020192738.

The predictive value of urine specific gravity in the diagnosis of vasovagal syncope in children and adolescents

BACKGROUND

Vasovagal syncope (VVS) is a kind of common neurally mediated syncope in children and adolescents. Decreased blood volume is one of the pathogenesis of VVS. The diagnosis of VVS is mainly based on head-up tilt test (HUTT), but some complications may easily occur when HUTT induces syncope. To find a simple and safe VVS diagnosis method can improve the VVS diagnosis efficiency.

AIMS OF THE STUDY

This was a prospective study. The study will explore the predictive value of urine specific gravity (USG) in the diagnosis of VVS in children and adolescents.

PATIENTS AND METHODS

Ninety-seven cases (43 males and 54 females, aged 4 to 16 years old, with an average age of 10.91 ± 2.18 years old) hospitalized due to unexplained premonitory syncope or syncope and diagnosed with VVS through HUTT from September 2014 to September 2018 were selected as VVS group. During the same period, 91 cases of children and adolescents, including 45 males and 46 females, aged from 5 to 15 years old, who underwent a healthy examination were matched as a control (control group). USG was measured in both groups.

RESULTS

The USG of VVS group was significantly lower than that of the control group (P < 0.01), and USG of females was lower than that of males in VVS group (P = 0.045). The sensitivity and specificity of USG in predicting VVS were evaluated by ROC curve. The area under the ROC curve was 0.751, standard error was 0.035, and 95% CI (0.683, 0.819) suggested that USG was of moderate predictive value in the diagnosis of VVS. As cut-off value of USG was 1.0185, the sensitivity and specificity and diagnostic coincidence rate of VVS were 74.39, 66.04 and 69.68%, respectively.

CONCLUSION

There are less USG in children and adolescents with VVS, especially lower USG in females. Therefore, USG has predictive value in the diagnosis of VVS in children and adolescents.

Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies

A rise in body core temperature and loss of body water via sweating are natural consequences of prolonged exercise in the heat. This review provides a comprehensive and integrative overview of how the human body responds to exercise under heat stress and the countermeasures that can be adopted to enhance aerobic performance under such environmental conditions. The fundamental concepts and physiological processes associated with thermoregulation and fluid balance are initially described, followed by a summary of methods to determine thermal strain and hydration status. An outline is provided on how exercise-heat stress disrupts these homeostatic processes, leading to hyperthermia, hypohydration, sodium disturbances, and in some cases exertional heat illness. The impact of heat stress on human performance is also examined, including the underlying physiological mechanisms that mediate the impairment of exercise performance. Similarly, the influence of hydration status on performance in the heat and how systemic and peripheral hemodynamic adjustments contribute to fatigue development is elucidated. This review also discusses strategies to mitigate the effects of hyperthermia and hypohydration on exercise performance in the heat by examining the benefits of heat acclimation, cooling strategies, and hyperhydration. Finally, contemporary controversies are summarized and future research directions are provided.

Sex Differences in Human Thermoregulation: Relevance for 2020 and Beyond

The participation of women in physically strenuous athletic and occupational tasks has increased substantially in the past decade. Female sex steroids have influences on thermoregulatory processes that could impact physical performance in the heat. Here, we summarize and evaluate the current literature regarding sex differences in thermoregulation and provide recommendations for heat-illness risk-mitigation strategies.

Pre-exercise hypohydration prevalence in soccer players: A quantitative systematic review

Pre-exercise hypohydration can impair soccer performance and has been extensively studied in different soccer populations. Therefore, the aim of this systematic review was to report hypohydration prevalence, measured by blood or urine samples, in different soccer populations based on sex (males and females), performance level (professional and recreational players) and context (training sessions and games). The Pubmed, Web of Science and SPORTDiscus databases were systematically searched until November 2018. Data were pooled to compare hypohydration prevalence between the different subgroups. Following the systematic search selection process, 24 studies were included. The results indicated that overall pre-exercise hypohydration prevalence was 63.3%, 37.4% and 58.8% for urine specific gravity (USG), urine osmolality (U Osm) and urine colour, respectively. Furthermore, no study implemented blood samples to examine hypohydration prevalence in soccer players. The subgroup analyses using USG data indicated that pre-exercise hypohydration prevalence was significantly higher amongst males (66.0%; p = 0.001), professional soccer players (66.2%; p = 0.020) and before a training session (79.6%; p < 0.001). Pre-exercise hypohydration prevalence was 46.8% among female soccer players, 55.6% in recreational soccer players and 41,3% before a game. The subgroup analyses using U Osm data indicated that hypohydration prevalence was significantly higher before a training session (52.6%; p = 0.023). Based on these results, it can be concluded that hypohydration prevalence in soccer players is of major concern. Future research should explore how pre-exercise hydration status can be improved in a sustainable way.

Sex-dependent differences in water homeostasis in wild-type and V-ATPase B1-subunit deficient mice

Men tend to dehydrate more than women after prolonged exercise, possibly due to lower water intake and higher perspiration rate. Women are prone to exercise-associated hyponatremia, primarily attributed to the higher water consumption causing hypervolemia. Since aquaporin-2 (AQP2) water channels in the kidney collecting duct (CD) principal cells (PCs) are involved in maintaining water balance, we investigated their role in sex-dependent water homeostasis in wild-type (WT) C57BL/6 mice. Because CD intercalated cells (ICs) may also be involved in water balance, we also assessed the urine concentrating ability of V-ATPase B1 subunit-deficient (Atp6v1b1^-/-) mice. Upon 12-hour water deprivation, urine osmolality increased by 59% in WT female mice and by only 28% in males. This difference was abolished in Atp6v1b1^-/- mice, in which dehydration induced a ~30% increase in urine osmolarity in both sexes. AQP2 levels were highest in WT females; female Atp6v1b1^-/- mice had substantially lower AQP2 expression than WT females, comparable to the low AQP2 levels seen in both Atp6v1b1^-/- and WT males. After dehydration, AQP2 relocates towards the PC apical pole, especially in the inner stripe and inner medulla, and to a greater extent in WT females than in WT males. This apparent sex-dependent concentrating advantage was absent in Atp6v1b1^-/- females, whose reduced AQP2 apical relocation was similar to WT males. Accordingly, female mice concentrate urine better than males upon dehydration due to increased AQP2 expression and mobilization. Moreover, our data support the involvement of ICs in water homeostasis, at least partly mediated by V-ATPase, in a sex-dependent manner.

Estimating policy-relevant health effects of ambient heat exposures using spatially contiguous reanalysis data

BACKGROUND

Regional National Weather Service (NWS) heat advisory criteria in New York State (NYS) were based on frequency of heat events estimated by sparse monitoring data. These may not accurately reflect temperatures at which specific health risks occur in large geographic regions. The objectives of the study were to use spatially resolved temperature data to characterize health risks related to summertime heat exposure and estimate the temperatures at which excessive risk of heat-related adverse health occurs in NYS. We also evaluated the need to adjust current heat advisory threshold and messaging based on threshold temperatures of multiple health outcomes.

METHODS

We assessed the effect of multi-day lag exposure for maximum near-surface air temperature (Tmax) and maximum Heat Index derived from the gridded National Land Data Assimilation System (NLDAS) reanalysis dataset on emergency department (ED) visits/ hospitalizations for heat stress, dehydration, acute kidney failure (AKF) and cardiovascular diseases (CVD) using a case-crossover analysis during summers of 2008-2012. We assessed effect modification using interaction terms and stratified analysis. Thresholds were estimated using piecewise spline regression.

RESULTS

We observed an increased risk of heat stress (Risk ratio (RR) = 1.366, 95% confidence interval (CI): 1.347, 1.386) and dehydration (RR = 1.024, 95% CI: 1.021, 1.028) for every 1 °C increase in Tmax on the day of exposure. The highest risk for AKF (RR = 1.017, 95% CI: 1.014, 1.021) and CVD (RR = 1.001, 95% CI: 1.000, 1.002) were at lag 1 and 4 respectively. The increased risk of heat-health effects persists up to 6 days. Rural areas of NYS are at as high a risk of heat-health effects as urban areas. Heat-health risks start increasing at temperatures much lower than the current NWS criteria.

CONCLUSION

Reanalysis data provide refined exposure-response functions for health research, in areas with sparse monitor observations. Based on this research, rural areas in NYS had similar risk for health effects of heat. Heat advisories in New York City (NYC) had been reviewed and lowered previously. As such, the current NWS heat advisory threshold was lowered for the upstate region of New York and surrounding areas. Enhanced outreach materials were also developed and disseminated to local health departments and the public.

Water Intake from the Points of View of Rhazes and Avicenna

Owing to the effect of acute and chronic hypohydration on health and the lethal effects of hyperhydration, an appropriate amount of water intake is important for each individual. Traditional Iranian medicine (TIM) is a holistic system one of whose important parts deals with lifestyles and how to maintain health, including the amount of water intake for every person and the appropriate principles of drinking water. In this study, Avicenna's Canon of Medicine, Rhazes' Benefits of Food and Its Harmfulness, and conventional medical articles were reviewed to evaluate the amount of water intake for each person and the principles of drinking water. TIM has expressed an individualized difference in the amount of water intake in the form of temperament and the relationship between the appropriate time of drinking water with other daily activities. In this view, drinking water at the inappropriate time causes liver and gastrointestinal diseases; it can create the foundation for conducting new studies in the field of appropriate water intake and lifestyle changes to reduce malnutrition complications.

Rehydrating efficacy of maple water after exercise-induced dehydration

Dehydration impairs physiological function and physical performance, thus understanding effective rehydration strategies is paramount. Despite growing interest in natural rehydrating beverages, no study has examined maple water (MW).

PURPOSE

To investigate the rehydrating efficacy of MW after exercise-induced dehydration.

METHODS

Using a single-blind, counterbalanced, crossover design, we compared the rehydrating efficacy of MW vs. maple-flavored bottled water (control) in 26 young healthy (22 ± 4 yrs., 24 ± 4 kg/m²) males (n = 13) and females (n = 13) after exercise-induced dehydration (~ 2.0%ΔBody Weight [BW]) in the heat (30 °C, 50% relative humidity [RH]). Hydration indicators (BW, salivary and urine osmolality [SOsm/UOsm], urine specific gravity [USG], urine volume [UV], urine color [UC]), thirst, fatigue, and recovery (heart rate [HR)], and HR variability [HRV]) were taken at baseline, post-exercise, 0.5, 1, and 2 h post-consumption of 1 L of MW or control.

RESULTS

Following similar dehydration (~ 2%ΔBW), MW had no differential (p > 0.05) impact on any measure of rehydration. Likely due to greater beverage osmolality (81 ± 1.4 vs. 11 ± 0.7 mOsmol/kg), thirst sensation remained 12% higher with MW (p <  0.05). When sex was considered, females had lower UV, elevated UOsm (p < 0.05), trends for higher ΔBW, USG, but similar SOsm. Analysis of beverages and urine for antioxidant potential (AP) revealed a four-fold greater AP in MW, which increased peak urine AP (9.4 ± 0.7 vs. 7.6 ± 1.0 mmol, MW vs. control, p <  0.05).

CONCLUSION

Electrolyte-containing MW, was similar in effectiveness to water, but has antioxidant properties. Furthermore, trends for sex differences were discovered in urinary, but not salivary, hydration markers, with discrepancies in kinetics between fluid compartments both warranting further study.

Variability of Body Mass and Urine Specific Gravity in Elite Male Field Hockey Players During a Pre-Olympic Training Camp

This field-based observational study was designed to examine the intraindividual variation of first morning body mass and urine specific gravity (Usg) in male hockey players (n = 22) during a 10-day training camp. It was also designed to evaluate the prevalence and interrelationship of morning hypohydration and postmatch dehydration using Usg and changes in body mass, respectively. Body mass and Usg were measured upon waking; body mass was also measured before and after matches. Individual means, SD, and coefficient of variation (CV) were calculated for morning body mass and Usg using 3, 6, and 8 days. Daily prevalence for euhydration and postmatch dehydration using morning Usg (<1.020) and changes in body mass (>-2%), respectively, were determined. Measurement of morning body mass and Usg for 3 days had low variability (CV < 1%) with no improvement at 6 or 8 days. Between 36% and 73% of players were considered euhydrated based on morning Usg. Postmatch body mass was reduced >1% in 50-85% of players, with up to 40% experiencing changes >-2%. Postmatch changes in body mass were unrelated to Usg the subsequent morning. These outcomes can be helpful in establishing criteria for detecting meaningful changes in morning body mass and Usg in similar settings, helping to monitor hydration status in elite male athletes. Despite ample fluid availability and consumption, many players experienced hypohydration and dehydration during the camp, indicating that careful monitoring and an individual fluid replacement approach are warranted in these environments.

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.

Prevalence of Dehydration Before Training Sessions, Friendly and Official Matches in Elite Female Soccer Players

This study aimed to evaluate and compare the hydration states prior to different sporting events (training sessions, friendly and official matches) in elite female soccer players and relate that to the importance that the player attached to the hydration state as a determinant of sports performance. The hydration state of 17 female elite soccer players (age: 21.5 ± 3 years; body mass: 62 ± 6 kg; body height: 165 ± 9 cm) was determined by measuring their urine specific gravity (USG) prior to three different sports events: training sessions (PT), friendly (PF) and official (PO) matches. The importance that each player attached to the hydration state as a determinant of sports performance was evaluated through a simple questionnaire. An average of 47.05% of the soccer players were severely dehydrated (USG > 1.030), 33.33% were significantly dehydrated (USG > 1.020), 17.64% were mildly dehydrated (USG > 1.010) and 1.96% were euhydrated (USG < 1.010). The average USG was 1.027 ± 0.007 (PT = 1.029 ± 0.009; PF = 1.023 ± 0.010 and PO = 1.030 ± 0.006). Differences were found between urine specific gravity prior to a friendly and an official match (p = 0.03). No relationship was found between urine specific gravity and the importance each player attached to the hydration state as a determinant of sports performance. The results show that dehydration is the most prevalent hydration state of elite soccer players before training sessions, friendly and official matches. Players were most dehydrated prior to official matches, which was unlinked to the players’ perceived importance of hydration for sports performance.

Dehydration, skeletal muscle damage and inflammation before the competitions among the elite wrestlers

[Purpose] The present study aimed to identify weight-loss and hydration levels before competitions among elite wrestlers and determine the skeletal muscle damage and inflammation levels after dehydration. [Subjects] Seventy-two elite wrestlers who participated in the Turkish Wrestling Championship. [Methods] With the help of specialists, 5 cc of blood were drawn from the forearm veins of the wrestlers. Laboratory analyses of Na(+), BUN, Glucose, CK, LDH, AST, ALT, C-RP levels were performed. Using a mathematical formula for hydration the POsm levels of the athletes were calculated. [Results] The wrestlers were divided into two groups based on hydration status. There were significant correlations between hydration indicators of Na(+), BUN and PBWL values. There were significant differences between AST, LDH, CK values and skeletal muscle damage indicators of the two groups, but there were no significant differences between the inflammation levels and C-RP values of the groups. [Conclusion] No differences existed in inflammation levels among the wrestlers, although dehydrated wrestlers suffered from higher level of skeletal muscle damage than wrestlers who were not dehydrated.

A Temperature-Based Bioimpedance Correction for Water Loss Estimation During Sports

The amount of total body water (TBW) can be estimated based on bioimpedance measurements of the human body. In sports, TBW estimations are of importance because mild water losses can impair muscular strength and aerobic endurance. Severe water losses can even be life threatening. TBW estimations based on bioimpedance, however, fail during sports because the increased body temperature corrupts bioimpedance measurements. Therefore, this paper proposes a machine learning method that eliminates the effects of increased temperature on bioimpedance and, consequently, reveals the changes in bioimpedance that are due to TBW loss. This is facilitated by utilizing changes in skin and core temperature. The method was evaluated in a study in which bioimpedance, temperature, and TBW loss were recorded every 15 min during a 2-h running workout. The evaluation demonstrated that the proposed method is able to reduce the error of TBW loss estimation by up to 71%, compared to the state of art. In the future, the proposed method in combination with portable bioimpedance devices might facilitate the development of wearable systems for continuous and noninvasive TBW loss monitoring during sports.