Low daily water intake profile-is it a contributor to disease?

Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration (UD; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or UD is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake-a simple and cost-effective dietary modification.

ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity.

ABSTRACT: Exertional heat stroke is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and exertional heat stroke. Identifying the athlete with suspected exertional heat stroke early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from exertional heat stroke is variable and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

Countermovement jump, handgrip, and balance performance change during euhydration, mild-dehydration, rehydration, and ad libitum drinking.

Objective: To examine the effects of euhydration, mild-dehydration, rehydration, and ad libitum drinking on countermovement jump (CMJ), handgrip strength, and performance of balance error scoring system test (BESS). Methods: Eighteen healthy male subjects (mean[M]±standard deviation[SD]; age, 23±3y; body mass, 80.1 ± 9.7 kg; height, 175.8 ± 5.7 cm) participated in this study. Participants reported to the laboratory to perform CMJ, handgrip strength, and BESS with different hydration statuses (euhydrated, EUH; when they initially sensed thirst, THIRST; dehydrated, DEH; following 30 minutes of rehydration, REH; and following 24-h ad libitum drinking, AD). Results: CMJ at EUH (M±SD; 54.6 ± 3.0 cm) was significantly higher than DEH (52.8 ± 3.0 cm, p = 0.027) and REH (52.6 ± 2.8 cm, p < 0.001). However, there was no difference between DEH and REH (p = 0.643). CMJ at THIRST (54.9 ± 3.0 cm, p = 0.004) was higher than REH. Also, AD (53.8 ± 2.8 cm, p = 0.027) was higher than REH. In left handgrip strength, THIRST (48.6 ± 9.5 kg) was higher than EUH (46.7 ± 10.1 kg, p = 0.018), DEH (45.8 ± 10.0 kg, p = 0.013), REH (46.1 ± 9.5 kg, p = 0.004), and AD (47.1 ± 9.7 kg, p = 0.05). Additionally, in the single-leg stance on a foam pad, more BESS errors were found at THIRST (6 ± 2) compared to EUH (5 ± 2, p = 0.007) and AD (5 ± 2, p = 0.002). Conclusion: The findings of this study were: ∼2% of mild dehydration induced by 24-h fluid restriction decreased lower body power measured by CMJ, acute rehydration did not restore the loss of lower body power induced by dehydration, and ∼0.5-0.9% of dehydration did not decrease lower body power.

Dietary triggers of gut inflammation following exclusive enteral nutrition in children with Crohn's disease: a pilot study.

BACKGROUND: The anti-inflammatory effect of exclusive enteral nutrition on the gut of children with Crohn's disease is rapidly lost after food reintroduction. This study assessed disease dietary triggers following successful treatment with exclusive enteral nutrition. METHODS: Nutrient intake, dietary patterns and dietary biomarkers in faeces (gluten immunogenic peptides, undigestible starch, short chain fatty acids) were assessed in 14 children with Crohn's disease during early food reintroduction, following exclusive enteral nutrition. Groups above (Group A) and below (Group B) the median levels of faecal calprotectin after food reintroduction were assigned for comparative analysis. RESULTS: Intakes of fibre, gluten-containing cereals and red and processed meat were significantly higher in Group A than Group B; (median [Q1, Q3], g/day; Fibre: 12.1 [11.2, 19.9] vs. 9.9 [7.6, 12.1], p = 0.03; Red and processed meat: 151 [66.7, 190] vs. 63.3 [21.7, 67], p = 0.02; gluten-containing cereals: 289 [207, 402] vs. 203 [61, 232], p = 0.035). A diet consisting of cereals and meat products was predictive (92% accuracy) of higher faecal calprotectin levels after food reintroduction. In faeces, butyrate levels, expressed as absolute concentration and relative abundance, were higher in Group A than Group B by 28.4 µmol/g (p = 0.015) and 6.4% (p = 0.008), respectively. Levels of gluten immunogenic peptide and starch in faeces did not differ between the two groups. CONCLUSIONS: This pilot study identified potential dietary triggers of gut inflammation in children with Crohn's disease after food reintroduction following treatment with exclusive enteral nutrition. TRIAL REGISTRATION: Clinical trials.gov registration number: NCT02341248; Clinical trials.gov URL: https://clinicaltrials.gov/ct2/show/NCT02341248 (retrospectively registered).

Hydration for health hypothesis: a narrative review of supporting evidence.

PURPOSE: An increasing body of evidence suggests that excreting a generous volume of diluted urine is associated with short- and long-term beneficial health effects, especially for kidney and metabolic function. However, water intake and hydration remain under-investigated and optimal hydration is poorly and inconsistently defined. This review tests the hypothesis that optimal chronic water intake positively impacts various aspects of health and proposes an evidence-based definition of optimal hydration. METHODS: Search strategy included PubMed and Google Scholar using relevant keywords for each health outcome, complemented by manual search of article reference lists and the expertise of relevant practitioners for each area studied. RESULTS: The available literature suggest the effects of increased water intake on health may be direct, due to increased urine flow or urine dilution, or indirect, mediated by a reduction in osmotically -stimulated vasopressin (AVP). Urine flow affects the formation of kidney stones and recurrence of urinary tract infection, while increased circulating AVP is implicated in metabolic disease, chronic kidney disease, and autosomal dominant polycystic kidney disease. CONCLUSION: In order to ensure optimal hydration, it is proposed that optimal total water intake should approach 2.5 to 3.5 L day-1 to allow for the daily excretion of 2 to 3 L of dilute (< 500 mOsm kg-1) urine. Simple urinary markers of hydration such as urine color or void frequency may be used to monitor and adjust intake.

Epstein-Barr Virus Status and Subsequent Thiopurine Exposure Within a Paediatric Inflammatory Bowel Disease Population.

ABSTRACT: The use of thiopurine therapy in Epstein-Barr virus (EBV)-naïve inflammatory bowel disease (IBD) patients remains controversial due to a risk of EBV-associated complications. We evaluated EBV status and outcomes within our paediatric IBD population over an 8-year period; finding that 217 of 409 (53%) screened patients were seropositive for EBV at IBD diagnosis; that thiopurines were used in 189 of 217 (87%) seropositive and 159 of 192 (83%) seronegative patients (P = 0.22); and that 7 of 192 (4%) previously seronegative patients subsequently tested positive for EBV with 6 of 7 (86%) patients having concurrently recorded thiopurine use. All six patients continued thiopurine with/without a period of cessation; no EBV-associated lymphoproliferative disorders/serious complications were recorded within our cohort. A significant proportion of our patients would not receive thiopurine therapy should their use be avoided in EBV-negative patients (47%) or seronegative males (30%). The small but significant risks of thiopurine treatment must be balanced against the potential benefits of successful IBD management; further research into this is required.

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.

ACSM Expert Consensus Statement on Exertional Heat Illness: Recognition, Management, and Return to Activity.

ABSTRACT: Exertional heat stroke (EHS) is a true medical emergency with potential for organ injury and death. This consensus statement emphasizes that optimal exertional heat illness management is promoted by a synchronized chain of survival that promotes rapid recognition and management, as well as communication between care teams. Health care providers should be confident in the definitions, etiologies, and nuances of exertional heat exhaustion, exertional heat injury, and EHS. Identifying the athlete with suspected EHS early in the course, stopping activity (body heat generation), and providing rapid total body cooling are essential for survival, and like any critical life-threatening situation (cardiac arrest, brain stroke, sepsis), time is tissue. Recovery from EHS is variable, and outcomes are likely related to the duration of severe hyperthermia. Most exertional heat illnesses can be prevented with the recognition and modification of well-described risk factors ideally addressed through leadership, policy, and on-site health care.

Urinary markers of hydration during 3-day water restriction and graded rehydration.

PURPOSE: This investigation had three purposes: (a) to evaluate changes in hydration biomarkers in response to a graded rehydration intervention (GRHI) following 3 days of water restriction (WR), (b) assess within-day variation in urine concentrations, and (c) quantify the volume of fluid needed to return to euhydration as demonstrated by change in Ucol. METHODS: 115 adult males and females were observed during 1 week of habitual fluid intake, 3 days of fluid restriction (1000 mL day-1), and a fourth day in which the sample was randomized into five different GRHI groups: no additional water, CON; additional 500 mL, G+0.50; additional 1000 mL, G+1.00; additional 1500 mL, G+1.50; additional 2250 mL, G+2.25. All urine was collected on 1 day of the baseline week, during the final 2 days of the WR, and during the day of GRHI, and evaluated for urine osmolality, color, and specific gravity. RESULTS: Following the GRHI, only G+1.50 and G+2.25 resulted in all urinary values being significantly different from CON. The mean volume of water increase was significantly greater for those whose Ucol changed from > 4 to < 4 (+ 1435 ± 812 mL) than those whose Ucol remained ≥ 4 (+ 667 ± 722 mL, p < 0.001). CONCLUSIONS: An additional 500 mL of water is not sufficient, while approximately 1500 mL of additional water (for a total intake between 2990 and 3515 mL day-1) is required to return to a urine color associated with adequate water intake, following 3 days of WR.

Metabolism, bioenergetics and thermal physiology: influences of the human intestinal microbiota.

The micro-organisms which inhabit the human gut (i.e. the intestinal microbiota) influence numerous human biochemical pathways and physiological functions. The present review focuses on two questions, 'Are intestinal microbiota effects measurable and meaningful?' and 'What research methods and variables are influenced by intestinal microbiota effects?'. These questions are considered with respect to doubly labelled water measurements of energy expenditure, heat balance calculations and models, measurements of RMR via indirect calorimetry, and diet-induced energy expenditure. Several lines of evidence suggest that the intestinal microbiota introduces measurement variability and measurement errors which have been overlooked in research studies involving nutrition, bioenergetics, physiology and temperature regulation. Therefore, we recommend that present conceptual models and research techniques be updated via future experiments, to account for the metabolic processes and regulatory influences of the intestinal microbiota.

Heat Exposure and Hypohydration Exacerbate Physiological Strain During Load Carrying.

Adams, EL, Casa, DJ, Huggins, RA, DeMartini-Nolan, JK, Stearns, RL, Kennedy, RM, Bosworth, MM, DiStefano, LJ, Armstrong, LE, and Maresh, CM. Heat exposure and hypohydration exacerbate physiological strain during load carrying. J Strength Cond Res 33(3): 727-735, 2019-Heat exposure and hypohydration induce physiological and psychological strain during exercise; however, it is unknown if the separate effects of heat exposure and hypohydration are synergistic when co-occurring during loaded exercise. This study compared separate and combined effects of heat exposure and hypohydration on physiological strain, mood state, and visual vigilance during loaded exercise. Twelve men (mean ± SD; age, 20 ± 2 years; body mass, 74.0 ± 8.2 kg; maximal oxygen uptake, 57.0 ± 6.0 ml·kg·min) completed 4 trials under the following conditions: euhydrated temperate (EUT), hypohydrated temperate (HYT), euhydrated hot (EUH), and hypohydrated hot (HYH). Exercise was 90 minutes of treadmill walking (∼50% V[Combining Dot Above]O2max, 5% grade) while carrying a 45-lb rucksack. Profile of Mood States and the Scanning Visual Vigilance Test were completed before and after exercise. The separate effects of heat exposure (EUH) and hypohydration (HYT) on post-exercise rectal temperature (Tre) were similar (38.25 ± 0.63°C vs. 38.22 ± 0.29°C, respectively, p > 0.05), whereas in combination (HYH), post-exercise Tre was far greater (39.32 ± 0.43°C). Increase in Tre per 1% body mass loss (BML) for HYH (vs. EUH) was greater than HYT (vs. EUT) (0.32 vs. 0.04°C, respectively, p = 0.02); heart rate increase per 1% BML for HYH (vs. EUH) was 7 b·min compared with HYT (vs. EUT) at 3 b·min (p = 0.30). Hypohydrated hot induced greater mood disturbance (post-exercise - pre-exercise) (35 ± 21 units) compared with other conditions (EUT = 3 ± 9 units; HYT = 3 ± 16 units; EUH = 16 ± 26 units; p < 0.001). No differences occurred in visual vigilance (p > 0.05). Independently, heat exposure and hypohydration induced similar physiological strain during loaded exercise; when combined, heat exposure with hypohydration, synergistically exacerbated physiological strain and mood disturbance.

Urine color as an indicator of urine concentration in pregnant and lactating women.

AIM: Urine concentration measured via osmolality (U OSM) and specific gravity (U SG) reflects the adequacy of daily fluid intake, which has important relationships to health in pregnant (PREG) and lactating (LACT) women. Urine color (U COL) may be a practical, surrogate marker for whole-body hydration status. PURPOSE: To determine whether U COL was a valid measure of urine concentration in PREG and LACT, and pair-matched non-pregnant, non-lactating control women (CON). METHODS: Eighteen PREG/LACT (age 31 ± 1 years, pre-pregnancy BMI 24.3 ± 5.9 kg m-2) and eighteen CON (age 29 ± 4 years, BMI 24.1 ± 3.7 kg m-2) collected 24-h and single-urine samples on specified daily voids at five time points (15 ± 2, 26 ± 1, and 37 ± 1 weeks gestation, 3 ± 1 and 9 ± 1 weeks postpartum during lactation; CON visits were separated by similar time intervals) for measurement of 24-h U OSM, U SG, and U COL and single-sample U OSM and U COL. RESULTS: Twenty-four-hour U COL was significantly correlated with 24-h U OSM (r = 0.6085-0.8390, P < 0.0001) and 24-h U SG (r = 0.6213-0.8985, P < 0.0001) in all groups. A 24-h U COL ≥ 4 (AUC = 0.6848-0.9513, P < 0.05) and single-sample U COL ≥ 4 (AUC = 0.9094-0.9216, P < 0.0001) indicated 24-h U OSM ≥ 500 mOsm kg-1 (representing inadequate fluid intake) in PREG, LACT, and CON. CONCLUSIONS: Urine color was a valid marker of urine concentration in all groups. Thus, PREG, LACT, and CON can utilize U COL to monitor their daily fluid balance. Women who present with a U COL ≥ 4 likely have a U OSM ≥ 500 mOsm kg-1 and should increase fluid consumption to improve overall hydration status.

Relationships between hydration biomarkers and total fluid intake in pregnant and lactating women.

INTRODUCTION: Previous research established significant relationships between total fluid intake (TFI) and urinary biomarkers of the hydration process in free-living males and females; however, the nature of this relationship is not known for pregnant (PREG) and lactating (LACT) women. PURPOSE: To determine the relationship between urinary and hematological hydration biomarkers with TFI in PREG and LACT. METHODS: Eighteen PREG/LACT (age: 31 ± 3 years, pre-pregnancy BMI: 24.26 ± 5.85 kg m-2) collected 24-h urine samples, recorded TFI, and provided a blood sample at 5 time points (15 ± 2, 26 ± 1, 37 ± 1 weeks gestation, 3 ± 1 and 9 ± 1 weeks postpartum during lactation); 18 pair-matched non-pregnant (NP), non-lactating (NL) women (age: 29 ± 4 years, BMI: 24.1 ± 3.7 kg m-2) provided samples at similar time intervals. Twenty-four-hour urine volume (U VOL), osmolality (U OSM), specific gravity (U SG), and color (U COL) were measured. Hematocrit, serum osmolality (S OSM), and serum total protein (S TP) were measured in blood. RESULTS: Significant relationships were present between TFI and urinary biomarkers in all women (P < 0.004); these relationships were not different between PREG and NP, and LACT and NL, except U VOL in PREG (P = 0.0017). No significant relationships between TFI and hematological biomarkers existed (P > 0.05). CONCLUSION: Urinary biomarkers of hydration, but not hematological biomarkers, have a strong relationship with TFI in PREG, LACT, NP, and NL women. These data suggest that urinary biomarkers of hydration reflect TFI during pregnancy and breast-feeding.

Monitoring Body Water Balance in Pregnant and Nursing Women: The Validity of Urine Color.

BACKGROUND: Urine osmolality (UOSM) reflects the renal regulation of excess fluid or deficit fluid, and therefore, serves as a marker of hydration status. Little is known about monitoring hydration in pregnant and lactating women despite significant physiological challenges to body water balance during that time. Therefore, we designed a study to assess if urine color (UCOL), an inexpensive and practical method, was a valid means of assessing urine concentration. Twenty-four hour UCOL was significantly correlated with 24 h UOSM in all women: pregnant, lactating, and control (r = 0.61-0.84, all p < 0.001). Utilizing a receiver operating characteristic statistical analysis, we found that 24 h and single sample UCOL had excellent diagnostic accuracy for identifying UOSM ≥500 mOsm·kg-1 in all women (area under the curve = 0.68-0.95, p < 0.001-0.46), and the UCOL that reflected this cut off was ≥4 on the UCOL chart. SUMMARY: Therefore, UCOL is a valid marker of urine concentration and ultimately hydration status in pregnant, lactating, and non-pregnant, non-lactating women. For pregnant, lactating, and control women, the UCOL chart is a valid tool that can be used to monitor urine concentration in a single sample or over the course of the day via a 24 h sample. Key Message: Women who present with a UCOL of 4 or more likely have a UOSM ≥500 mOsm·kg-1. Given the positive health benefits associated with UOSM <500 mOsm·kg-1, women should aim for a 1, 2, or 3 on the UCOL chart. If a UCOL of ≥4 is observed, women should consider increasing fluid consumption to improve hydration status.

Exertional Hyponatremia and Serum Sodium Change During Ultraendurance Cycling.

INTRODUCTION: Exertional hyponatremia (EH) during prolonged exercise involves all avenues of fluid-electrolyte gain and loss. Although previous research implicates retention of excess fluid, EH may involve either loss, gain, or no change of body mass. Thus, the etiology, predisposing factors, and recommendations for prevention are vague-except for advice to avoid excessive drinking. PURPOSE: This retrospective field study presents case reports of two unacquainted recreational cyclists (LC, 31y and AM, 39 years) who began exercise with normal serum electrolytes but finished a summer 164-km ride (ambient, 34±5°C) with a serum [Na+] of 130 mmol/L. METHODS: To clarify the etiology of EH, their pre- and post-exercise measurements were compared to a control group (CON) of 31 normonatremic cyclists (mean ± SD; 37±6 years; 141±3 mmol Na+/L). RESULTS: Anthropomorphic characteristics, exercise time, and post-exercise ratings of thermal sensation, perceived exertion and muscle cramp were similar for LC, AM and CON. These two hyponatremic cyclists consumed a large and similar volume of fluid (191 and 189 ml/kg), experienced an 11 mmol/L decrease of serum [Na+], reported low thirst sensations; however, LC gained 3.1 kg (+4.3% of body mass) during 8.9 hr of exercise and AM maintained body mass (+0.1kg, +0.1%, 10.6h). In the entire cohort (n = 33), post-event serum [Na+] was strongly correlated with total fluid intake (R2 = 0.45, p < .0001), and correlated moderately with dietary sodium intake (R2=0.28, p = .004) and body mass change (R2 = 0.22, p = .02). Linear regression analyses predicted the threshold of EH onset (<135 mmol Na+/L) as 168 ml fluid/kg. CONCLUSIONS: The wide range of serum [Na+] changes (+6 to -11 mmol/L) led us to recommend an individualized rehydration plan to athletes because the interactions of factors were complex and idiosyncratic.

Precision, Accuracy, and Performance Outcomes of Perceived Exertion vs. Heart Rate Guided Run-training.

Johnson, EC, Pryor, RR, Casa, DJ, Ellis, LA, Maresh, CM, Pescatello, LS, Ganio, MS, Lee, EC, and Armstrong, LE. Precision, accuracy, and performance outcomes of perceived exertion vs. heart rate guided run-training. J Strength Cond Res 31(3): 630-637, 2017-The purpose of this investigation was to compare run-prescription by heart rate (HR) vs. rating of perceived exertion (RPE) during 6 weeks to determine which is superior for consistent achievement of target intensities and improved performance. Forty untrained men participated in this laboratory-controlled and field-controlled trial. Participants were divided into heart rate (HRTG) and rating of perceived exertion training groups (RPETG). All underwent maximal-graded exercise testing and a 12-minute run test before and after training. Intensity was prescribed as either a target HR or RPE that corresponded to 4 relative intensity levels: 45, 60, 75, and 90% V[Combining Dot Above]O2 reserve (V[Combining Dot Above]O2R). Mean exercise intensity over the 6 weeks did not differ between HRTG (65.6 ± 7.2%HRR) and RPETG (61.9 ± 9.0%HRR). V[Combining Dot Above]O2max (+4.1 ± 2.5 ml·kg·min) and 12 minutes run distance (+240.1 ± 150.1 m) improved similarly in HRTG and RPETG (p > 0.05). HRTG displayed lower coefficients of variation (CV) (5.9 ± 4.1%, 3.3 ± 3.8%, and 3.0 ± 2.2%) and %error (4.1 ± 4.7%, 2.3 ± 4.1% and 2.6 ± 3.2%) at 45, 60, and 75% V[Combining Dot Above]O2R compared with RPETG (CV 11.1 ± 5.0%, 7.7 ± 4.1% and 5.6 ± 3.2%; all p < 0.005) %error (15.7 ± 9.2%, 10.6 ± 9.2% and 6.7 ± 3.2%; all p < 0.001), respectively. Overall, HR-prescribed and RPE-prescribed run-training resulted in similar exercise intensity and performance outcomes over 6 weeks. Differences in the CV and %error suggest use of HR monitoring for individuals that are new to running as it improves precision and accuracy but does not increase performance improvements across 6 weeks.

Effect of Caffeine on Perceived Soreness and Functionality Following an Endurance Cycling Event.

Caldwell, AR, Tucker, MA, Butts, CL, McDermott, BP, Vingren, JL, Kunces, LJ, Lee, EC, Munoz, CX, Williamson, KH, Armstrong, LE, and Ganio, MS. Effect of caffeine on perceived soreness and functionality following an endurance cycling event. J Strength Cond Res 31(3): 638-643, 2017-Caffeine can reduce muscle pain during exercise; however, the efficacy of caffeine in improving muscle soreness and recovery from a demanding long-duration exercise bout has not been established. The purpose of this study was to investigate the effects of caffeine intake on ratings of perceived muscle soreness (RPMS) and perceived lower extremity functionality (LEF) following the completion of a 164-km endurance cycling event. Before and after cycling RPMS (1-to-6; 6 = severe soreness) and LEF (0-to-80; 80 = full functionality) were assessed by questionnaires. Subjects ingested 3 mg/kg body mass of caffeine or placebo pills in a randomized, double-blind fashion immediately after the ride and for the next 4 mornings (i.e., ∼800 hours) and 3 afternoons (i.e., ∼1200 hours). Before each ingestion, RPMS and LEF were assessed. Afternoon ratings of LEF were greater with caffeine ingestion the first day postride (65.0 ± 6.1 vs. 72.3 ± 6.7; for placebo and caffeine, respectively; p = 0.04), but at no other time points (p > 0.05). The caffeine group tended to have lower overall RPMS in the afternoon versus placebo (i.e., main effect of group; 1.1 ± 0.2 vs. 0.5 ± 0.2; p = 0.09). Afternoon RPMS for the legs was significantly lower in the caffeine group (main effect of caffeine; 1.3 ± 0.2 vs. 0.5 ± 0.3; p = 0.05). In conclusion, ingesting caffeine improved RPMS for the legs, but not LEF in the days following an endurance cycling event. Athletes may benefit from ingesting caffeine in the days following an arduous exercise bout to relieve feelings of soreness and reduced functionality.

Blood Hemostatic Changes During an Ultraendurance Road Cycling Event in a Hot Environment.

OBJECTIVE: This study aims to examine blood hemostatic responses to completing a 164-km road cycling event in a hot environment. METHODS: Thirty-seven subjects (28 men and 9 women; 51.8±9.5 [mean±SD] y) completed the ride in 6.6±1.1 hours. Anthropometrics (height, body mass [taken also during morning of the ride], percent body fat [%]) were collected the day before the ride. Blood samples were collected on the morning of the ride (PRE) and immediately after (IP) the subject completed the ride. Concentrations of platelet, platelet activation, coagulation, and fibrinolytic markers (platelet factor 4, ß-thromboglobulin, von Willebrand factor antigen, thrombin-antithrombin complex, thrombomodulin, and D-Dimer) were measured. Associations between changes from PRE- to IP-ride were examined as a function of event completion time and subject characteristics (demographics and anthropometrics). RESULTS: All blood hemostatic markers increased significantly (P < .001) from PRE to IP. After controlling for PRE values, finishing time was negatively correlated with platelet factor 4 (r = 0.40; P = .017), while percent body fat (%BF) was negatively correlated with thrombin-antithrombin complex (r = -0.35; P = .038) and to thrombomodulin (r = -0.36; P = .036). In addition, male subjects had greater concentrations of thrombin-antithrombin complex (d = 0.63; P < .05) and natural logarithm thrombomodulin (d = 6.42; P < .05) than female subjects. CONCLUSION: Completing the 164-km road cycling event in hot conditions resulted in increased concentrations of platelet, platelet activation, coagulation, and fibrinolytic markers in both men and women. Although platelet activation and coagulation occurred, the fibrinolytic system markers also increased, which appears to balance blood hemostasis and may prevent clot formation during exercise in a hot environment.

Diagnosing dehydration? Blend evidence with clinical observations.

PURPOSE OF REVIEW: The purpose of the review is to provide recommendations to improve clinical decision-making based on the strengths and weaknesses of commonly used hydration biomarkers and clinical assessment methods. RECENT FINDINGS: There is widespread consensus regarding treatment, but not the diagnosis of dehydration. Even though it is generally accepted that a proper clinical diagnosis of dehydration can only be made biochemically rather than relying upon clinical signs and symptoms, no gold standard biochemical hydration index exists. Other than clinical biomarkers in blood (i.e., osmolality and blood urea nitrogen/creatinine) and in urine (i.e., osmolality and specific gravity), blood pressure assessment and clinical symptoms in the eye (i.e., tear production and palpitating pressure) and the mouth (i.e., thirst and mucous wetness) can provide important information for diagnosing dehydration. SUMMARY: We conclude that clinical observations based on a combination of history, physical examination, laboratory values, and clinician experience remain the best approach to the diagnosis of dehydration.

Urine colour change as an indicator of change in daily water intake: a quantitative analysis.

PURPOSE: Urine colour (U Col) is simple to measure, differs between low-volume and high-volume drinkers, and is responsive to changes in daily total fluid intake (TFI). However, to date, no study has quantified the relationship between a change in TFI and the resultant change in U Col. This analysis aimed to determine the change in TFI needed to adjust 24-h U Col by 2 shades on an 8-colour scale, and to evaluate whether starting U Col altered the relationship between the change in TFI and change in U Col. METHODS: We performed a pooled analysis on data from 238 healthy American and European adults (50 % male; age, 28 (sd 6) years; BMI 22.9 (sd 2.6) kg/m(2)), and evaluated the change in TFI, urine volume (U Vol), and specific gravity (U SG) associated with a change in U Col of 2 shades. RESULTS: The mean [95 % CI] change in TFI and U Vol associated with a decrease in U Col by 2 shades (lighter) was 1110 [914;1306] and 1011 [851;1172] mL/day, respectively, while increasing U Col by 2 shades (darker) required a reduction in TFI and U Vol of -1114 [-885;-1343] and -977 [-787;-1166] mL/day. The change in U Col was accompanied by changes in U SG (lighter urine: -.008 [-.007;-.010]; darker urine: +.008 [.006;.009]). Starting U Col did not significantly impact the TFI change required to modify U Col by 2 shades. CONCLUSIONS: Our results suggest a quantifiable relationship between a change in daily TFI and the resultant change in U Col, providing individuals with a practical means for evaluating and adjusting hydration behaviours.