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.

Characterizing Hydration Practices in Healthy Young Recreationally Active Adults-Is There Utility in First Morning Urine Sampling?

First morning urine (FMU) assessment would be a practical and convenient solution for clinically acceptable detection of underhydration prior to competition/training, and for the general public. Thus, we thus sought to determine the diagnostic accuracy of FMU as a valid indicator of recent (previous 24 hr, 5 days average) hydration practices. For 5 consecutive days and one final morning, 67 healthy women (n = 38) and men (n = 29; age: 20 [1] years, body mass index: 25.9 [5.5]) completed 24-hr diet logs for total water intake (from beverages and foods, absolute and relative to body mass), 24-hr urine and FMU collection (last morning only) for osmolality (Osm), specific gravity (SG), and color (Col), and morning blood sampling for plasma osmolality and copeptin. Correlations determined significance and relationship strength among FMU and all other variables. Area under the receiver operating characteristic curves, sensitivity, specificity, and positive likelihood ratios were employed using previously reported values to indicate underhydration (total water intake < 30 ml/kg, osmolality > 500, and >800 mOsm/kg, specific gravity > 1.017, and copeptin > 6.93 pmol/L). FMU_Osm and FMU_SG were significantly correlated (p < .05) to all variables except the previous 5-day plasma osmolality. FMU_Col was only significantly correlated with other color time intervals and total water intake per gram. FMU_Osm held greatest utility (area under the receiver operating characteristic curve, sensitivity, and specificity >80%) overall, with the best outcome being FMU_Osm indicating a previous 24-hr osmolality threshold of 500 mOsm/kg (FMU_Osm criterion >710 mOsm/kg and positive likelihood ratio = 5.9). With less effort and cost restriction, FMU is a viable metric to assess underhydration.

Effects of cold water immersion on circulating inflammatory markers at the Kona Ironman World Championship.

Cold water immersion (CWI) purportedly reduces inflammation and improves muscle recovery after exercise, yet its effectiveness in specific contexts (ultraendurance) remains unclear. Thus, our aim was to study hematological profiles, systemic inflammation, and muscle damage responses to a specific post-race CWI (vs. control) during recovery after the Ironman World Championship, a culmination of ∼100 000 athletes competing in global qualifying Ironman events each year. Twenty-nine competitors were randomized into either a CWI or control (CON) group. Physiological parameters and blood samples were taken at pre-race, after intervention (POST), and 24 (+1DAY) and 48 hours (+2DAY) following the race. Muscle damage markers (plasma myoglobin, serum creatine kinase) were elevated at POST, +1DAY, and +2DAY, while inflammatory cytokines interleukin (IL)-6, IL-8, and IL-10 and total leukocyte counts were increased only at POST. CWI had no effect on these markers. Numbers of the most abundant circulating cell type, neutrophils, were elevated at POST more so in CWI (p < 0.05, vs. CON). Despite that neutrophil counts may be a sensitive marker to detect subtle effects, CWI does not affect recovery markers 24- and 48-hours post-race (vs. CON). Overall, we determined that our short CWI protocol was not sufficient to improve recovery. Novelty: Ironman World Championship event increased circulating muscle damage markers, inflammatory markers, and hematological parameters, including circulating immune cell sub-populations that recover 24-48 hours after the race. 12-min CWI post-ultraendurance event affects the absolute numbers of neutrophils acutely, post-race (vs. CON), but does not impact recovery 24- and 48-hours post-race.

Hydration Biomarkers Are Related to the Differential Abundance of Fecal Microbiota and Plasma Lipopolysaccharide-Binding Protein in Adults.

INTRODUCTION: Prevalence of chronic hypohydration remains elevated among adults in the USA; however, the health effects of hypohydration in regards to human gut health have not been explored. METHODS: This study examined the relationship between total water intake, hydration biomarkers (first-morning urine specific gravity [FMUsg], first-morning urine volume [FMUvol], and plasma copeptin), fecal microbiota, and plasma lipopolysaccharide-binding protein (LBP) in adults (25-45 years, 64% female). Fecal microbiota composition was assessed using 16S rRNA gene sequencing (V4 region). Immunoassays quantified plasma copeptin and LBP in fasted venous blood samples. Dietary variables were measured using 7-day food records. Linear discriminant analysis effect size (LEfSe) analyzed differentially abundant microbiota based on median cutoffs for hydration markers. Multiple linear regressions examined the relationship between LBP and copeptin. RESULTS: LEfSe identified 6 common taxa at the genus or species level that were differentially abundant in FMUsg, total water (g/day), or plasma copeptin (µg/mL) groups when split by their median values. Uncultured species in the Bacteroides, Desulfovibrio, Roseburia, Peptococcus, and Akkermansia genera were more abundant in groups that might indicate poorer hydration status. Multivariate linear analyses revealed a positive relationship between plasma copeptin and LBP when controlling confounding variables (F(6,52) = 4.45, p = 0.002, R2 = 0.34). CONCLUSIONS: Taxa common between markers are associated with the intestinal mucus layer, which suggests a potential link between hydration status and intestinal mucus homeostasis. The relationship between LBP and copeptin indicates that copeptin may be sensitive to metabolic endotoxemia and potentially gut barrier function.

Progression of human subjective perceptions during euhydration, mild dehydration, and drinking.

Thirst motivates consumption of water necessary for optimal health and cognitive-physiological functions. Other than thirst, little is known about coexisting perceptions and moods that provide information to the brain and participate in body water homeostasis. The purpose of this investigation was to observe perceptions, somatic sensations, and moods during controlled changes of hydration status. During routine daily activities interspersed with laboratory visits, 18 healthy young men (age, 23±3 y; body mass, 80.13±10.61 kg) self-reported hourly ratings (visual analog scales, VAS) of 17 subjective perceptions, across two 24-h periods (ad libitum food and water intake while euhydrated; water restriction with dry food intake [WR]) and during a 30-min rehydration session (R30, 1.46±0.47 L water intake). At the end of WR, body mass loss reached 1.67 kg (2.12%). Distinct perceptions were identified during euhydration, WR and immediately after R30. Starting approximately 4 h after WR began (body mass loss of ∼0.5%), perceptual changes included progressively intensifying ratings of thirst, mouth dryness, desire for water, and pleasantness of drinking. In comparison, immediately after R30, participants reported a reversal of the perceptions observed during WR (above) plus cooler thermal sensation, increased satisfaction, and stomach fullness. These VAS ratings suggested that aversive moods contributed to drinking behavior and supported previously published animal studies. In conclusion, this investigation delineates previously unreported perceptions and their evolution (e.g., appearance, extinction, time course) that motivated drinking during WR and discouraged overdrinking after R30.

Inputs to Thirst and Drinking during Water Restriction and Rehydration.

Current models of afferent inputs to the brain, which influence body water volume and concentration via thirst and drinking behavior, have not adequately described the interactions of subconscious homeostatic regulatory responses with conscious perceptions. The purpose of this investigation was to observe the interactions of hydration change indices (i.e., plasma osmolality, body mass loss) with perceptual ratings (i.e., thirst, mouth dryness, stomach emptiness) in 18 free-living, healthy adult men (age, 23 ± 3 y; body mass, 80.09 ± 9.69 kg) who participated in a 24-h water restriction period (Days 1-2), a monitored 30-min oral rehydration session (REHY, Day 2), and a 24-h ad libitum rehydration period (Days 2-3) while conducting usual daily activities. Laboratory and field measurements spanned three mornings and included subjective perceptions (visual analog scale ratings, VAS), water intake, dietary intake, and hydration biomarkers associated with dehydration and rehydration. Results indicated that total water intake was 0.31 L/24 h on Day 1 versus 2.60 L/24 h on Day 2 (of which 1.46 L/30 min was consumed during REHY). The increase of plasma osmolality on Day 1 (297 ± 4 to 299 ± 5 mOsm/kg) concurrent with a body mass loss of 1.67 kg (2.12%) paralleled increasing VAS ratings of thirst, desire for water, and mouth dryness but not stomach emptiness. Interestingly, plasma osmolality dissociated from all perceptual ratings on Day 3, suggesting that morning thirst was predominantly non-osmotic (i.e., perceptual). These findings clarified the complex, dynamic interactions of subconscious regulatory responses with conscious perceptions during dehydration, rehydration, and reestablished euhydration.

Impact of Nutrient Intake on Hydration Biomarkers Following Exercise and Rehydration Using a Clustering-Based Approach.

We investigated the impact of nutrient intake on hydration biomarkers in cyclists before and after a 161 km ride, including one hour after a 650 mL water bolus consumed post-ride. To control for multicollinearity, we chose a clustering-based, machine learning statistical approach. Five hydration biomarkers (urine color, urine specific gravity, plasma osmolality, plasma copeptin, and body mass change) were configured as raw- and percent change. Linear regressions were used to test for associations between hydration markers and eight predictor terms derived from 19 nutrients merged into a reduced-dimensionality dataset through serial k-means clustering. Most predictor groups showed significant association with at least one hydration biomarker: 1) Glycemic Load + Carbohydrates + Sodium, 2) Protein + Fat + Zinc, 3) Magnesium + Calcium, 4) Pinitol, 5) Caffeine, 6) Fiber + Betaine, and 7) Water; potassium + three polyols, and mannitol + sorbitol showed no significant associations with any hydration biomarker. All five hydration biomarkers were associated with at least one nutrient predictor in at least one configuration. We conclude that in a real-life scenario, some nutrients may serve as mediators of body water, and urine-specific hydration biomarkers may be more responsive to nutrient intake than measures derived from plasma or body mass.

Diagnostic accuracy of urinary indices to detect mild dehydration in young men following acute riboflavin, Vitamin C or beetroot supplementation.

BACKGROUND: Individuals of all ages are encouraged to monitor their hydration status daily to prevent clinically severe fluid imbalances such as hyponatremia or dehydration. However, acute oral nutritional supplementation may alter urinary hydration assessments and potentially increase the likelihood of inappropriate clinical decisions or diagnosis. This investigation sought to examine the influence of three common over-the-counter nutritional supplements (beetroot, riboflavin, and Vitamin C) on urinary hydration assessments in physically active young men after a 2% exercise-induced dehydration. DESIGN: Eight males (Mean ± SD; age: 22 ± 3 yr; body mass index: 27 ± 5.0) consumed either a standard meal with supplementation (intervention) or a standard meal without supplementation (control). Participants performed a variety of aerobic or resistance exercises until reaching ≥2% body mass loss in a counter-balanced, double-blinded design. Following exercise participation, urine samples were collected for an 8 h observational period during which food consumption was replicated. Urine samples were analyzed for urine color, specific gravity, volume, and osmolality. Maintenance of ~2% body mass loss (2.6 ± 0.5%; range: 1.7-4.0%) was confirmed following the 8 h observational period. RESULTS: Statistically significant (p < 0.05) changes were noted in urine color following Vitamin C supplementation compared to control; however, the difference was not clinically meaningful. CONCLUSIONS: These findings indicate that urine color, specific gravity, and osmolality maintain clinical utility to detect moderate levels of dehydration in physically active men consuming commercially available doses of beetroot, riboflavin, or Vitamin C.

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

A long-standing body of clinical observations associates low 24-h total water intake (TWI = water + beverages + food moisture) with acute renal disorders such as kidney stones and urinary tract infections. These findings prompted observational studies and experimental interventions comparing habitual low volume (LOW) and high volume (HIGH) drinkers. Investigators have learned that the TWI of LOW and HIGH differ by 1-2 L·d-1, their hematological values (e.g., plasma osmolality, plasma sodium) are similar and lie within the laboratory reference ranges of healthy adults and both groups appear to successfully maintain water-electrolyte homeostasis. However, LOW differs from HIGH in urinary biomarkers (e.g., reduced urine volume and increased osmolality or specific gravity), as well as higher plasma concentrations of arginine vasopressin (AVP) and cortisol. Further, evidence suggests that both a low daily TWI and/or elevated plasma AVP influence the development and progression of metabolic syndrome, diabetes, obesity, chronic kidney disease, hypertension and cardiovascular disease. Based on these studies, we propose a theory of increased disease risk in LOW that involves chronic release of fluid-electrolyte (i.e., AVP) and stress (i.e., cortisol) hormones. This narrative review describes small but important differences between LOW and HIGH, advises future investigations and provides practical dietary recommendations for LOW that are intended to decrease their risk of chronic diseases.

Models of hydration and nutrition require environmental data.

OBJECTIVE: To recognize the causality of environmental factors (i.e. temperature, humidity and sun exposure) on nutritional variables, specifically body water balance and water-seeking behaviour. DESIGN: Author perspective. SETTING: Global. PARTICIPANTS: Not applicable. RESULTS: A free-standing code supplement is provided to facilitate investigators in accessing meteorological data for incorporation into analyses related to nutrition and hydration. CONCLUSIONS: Analytical models related to human hydration should account for the environment de rigueur.

Unexplained Variance in Hydration Study.

With the collection of water-intake data, the National Health and Nutrition Examination Survey (NHANES) is becoming an increasingly popular resource for large-scale inquiry into human hydration. However, are we leveraging this resource properly? We sought to identify the opportunities and limitations inherent in hydration-related inquiry within a commonly studied database of hydration and nutrition. We also sought to critically review models published from this dataset. We reproduced two models published from the NHANES dataset, assessing the goodness of fit through conventional means (proportion of variance, R2). We also assessed model sensitivity to parameter configuration. Models published from the NHANES dataset typically yielded a very low goodness of fit R2 < 0.15. A reconfiguration of variables did not substantially improve model fit, and the goodness of fit of models published from the NHANES dataset may be low. Database-driven inquiry into human hydration requires the complete reporting of model diagnostics in order to fully contextualize findings. There are several emergent opportunities to potentially increase the proportion of explained variance in the NHANES dataset, including novel biomarkers, capturing situational variables (meteorology, for example), and consensus practices for adjustment of co-variates.

Renal stress and kidney injury biomarkers in response to endurance cycling in the heat with and without ibuprofen.

Exercise, especially in the heat, can contribute to acute kidney injury, which can expedite chronic kidney disease onset. The additional stress of ibuprofen use is hypothesized to increase renal stress. OBJECTIVES: To observe the effects of endurance cycling in the heat on renal function. Secondarily, we investigated the effect of ibuprofen ingestion on kidney stress. DESIGN: Randomized, placebo controlled and observational methods were utilized. METHODS: Forty cyclists (52±9y, 21.7±6.5% body fat) volunteered and completed an endurance cycling event (5.7±1.2h) in the heat (33.2±5.0°C, 38.4±10.7% RH). Thirty-five participants were randomized to ingest a placebo (n=17) or 600mg ibuprofen (n=18) pre-event. A blood sample was drawn before and following the event. Serum creatinine was assessed by colorimetric assay. An ELISA was used to measure serum neutrophil gelatinase-associated lipocalin. Fractional excretion of sodium was calculated after urinary and serum electrolyte analyses. RESULTS: Placebo versus ibuprofen groups contributed no significant difference in any variable (p>0.05). Serum creatinine significantly increased from pre- (0.52±0.14mg/dL) to post-event (0.88±0.21mg/dL; p<0.001). Serum neutrophil gelatinase-associated lipocalin significantly increased (pre: 68.51±17.54ng/mL; post: 139.12±36.52ng/mL; p<0.001) and fractional excretion of sodium was significantly reduced from pre- (0.52±0.24%) to post-event (0.27±0.18%; p<0.001). CONCLUSIONS: Changes in renal biomarkers suggest mild acute kidney injury and reduced kidney function during a single bout of endurance cycling in the heat, without influence from moderate ibuprofen ingestion.

Influence of cold-water immersion on recovery of elite triathletes following the ironman world championship.

OBJECTIVES: Cold water immersion (CWI) has been widely used for enhancing athlete recovery though its use following an Ironman triathlon has never been examined. The purpose of this paper is to determine the influence of CWI immediately following an Ironman triathlon on markers of muscle damage, inflammation and muscle soreness. DESIGN: Prospective cohort study. METHODS: Thirty three (22 male, 11 female), triathletes participating in the Ironman World Championships volunteered to participate (mean±SD: age=40±11years; height=174.5±9.1cm; body mass=70±11.8kg; percent body fat=11.4±4.1%, finish time=11:03.00±01:25.08). Post race, participants were randomly assigned to a 10-min bout of 10°C CWI or no-intervention control group. Data collection occurred pre-intervention (PRE), post-intervention (POST), 16h (16POST) and 40h (40POST) following the race. Linear mixed model ANOVA with Bonferroni corrections were performed to examine group by time differences for delayed onset muscle soreness (DOMS), hydration indices, myoglobin, creatine kinase (CK), cortisol, C-reactive protein (CRP), IL-6 and percent body mass loss (%BML). Pearson's bivariate correlations were used for comparisons with finishing time. Alpha level was set a priori at 0.05. RESULTS: No significant group by time interactions occurred. Significant differences occurred for POST BML (-1.7±0.9kg) vs. 16POST, and 40POST BML (0.9±1.4, -0.1±1.2kg, respectively; p<0.001). Compared to PRE, myoglobin, CRP and CK remained significantly elevated at 40POST. Cortisol returned to PRE values by 16POST and IL-6 returned to PRE values by 40POST. CONCLUSION: A single bout of CWI did not provide any physiological benefit during recovery from a triathlon within 40h post race. Effect of CWI beyond this time is unknown.

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.

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.

The void in using urine concentration to assess population fluid intake adequacy or hydration status.

Urine concentration can be used to assess fluid intake adequacy or to diagnose dehydration. However, too often urine concentration is used inappropriately to draw dubious conclusions that could have harmful health and economic consequences. Inappropriate uses of urine concentration relate primarily to convenience sampling (timing) and problems related to convenience sampling (misapplication of thresholds), but a conceptual problem also exists with using urine concentration in isolation. The purpose of this Perspective article is to briefly explain the problematic nature of current practices and to offer a possible solution to improve practice with minimal added complication. When urine is used exclusively to assess fluid intake adequacy and hydration status in adults, we propose that only when urine concentration is high (>850 mmol/kg) and urine excretion rate is low (<850 mL/24 h) should suspicion of inadequate drinking or impending dehydration be considered. Prospective tests of the 850 × 850 thresholds will provide supporting evidence and/or help refine the best thresholds for men and women, young and old.

Hormonal and Thirst Modulated Maintenance of Fluid Balance in Young Women with Different Levels of Habitual Fluid Consumption.

BACKGROUND: Surprisingly little is known about the physiological and perceptual differences of women who consume different volumes of water each day. The purposes of this investigation were to (a) analyze blood osmolality, arginine vasopressin (AVP), and aldosterone; (b) assess the responses of physiological, thirst, and hydration indices; and (c) compare the responses of individuals with high and low total water intake (TWI; HIGH and LOW, respectively) when consuming similar volumes of water each day and when their habitual total water intake was modified. METHODS: In a single-blind controlled experiment, we measured the 24 h total water intake (TWI; water + beverages + food moisture) of 120 young women. Those who consumed the highest (HIGH, 3.2 ± 0.6 L·day(-1), mean ± SD) and the lowest (LOW, 1.6 ± 0.5 L·day(-1)) mean habitual TWI were identified and compared. Outcome variables were measured during two ad libitum baseline days, a four-day intervention of either decreased TWI (HIGH) or increased TWI (LOW), and one ad libitum recovery day. RESULTS: During the four-day intervention, HIGH and LOW experienced differences in thirst (p = 0.002); also, a statistically significant change of AVP occurred (main effect of TWI and day, p < 0.001), with no effect (TWI or day) on aldosterone and serum osmolality. Urine osmolality and volume distinguished HIGH from LOW (p = 0.002) when they consumed similar 24 h TWI.

Metabolic characteristics of keto-adapted ultra-endurance runners.

BACKGROUND: Many successful ultra-endurance athletes have switched from a high-carbohydrate to a low-carbohydrate diet, but they have not previously been studied to determine the extent of metabolic adaptations. METHODS: Twenty elite ultra-marathoners and ironman distance triathletes performed a maximal graded exercise test and a 180 min submaximal run at 64% VO2max on a treadmill to determine metabolic responses. One group habitually consumed a traditional high-carbohydrate (HC: n=10, %carbohydrate:protein:fat=59:14:25) diet, and the other a low-carbohydrate (LC; n=10, 10:19:70) diet for an average of 20 months (range 9 to 36 months). RESULTS: Peak fat oxidation was 2.3-fold higher in the LC group (1.54±0.18 vs 0.67±0.14 g/min; P=0.000) and it occurred at a higher percentage of VO2max (70.3±6.3 vs 54.9±7.8%; P=0.000). Mean fat oxidation during submaximal exercise was 59% higher in the LC group (1.21±0.02 vs 0.76±0.11 g/min; P=0.000) corresponding to a greater relative contribution of fat (88±2 vs 56±8%; P=0.000). Despite these marked differences in fuel use between LC and HC athletes, there were no significant differences in resting muscle glycogen and the level of depletion after 180 min of running (-64% from pre-exercise) and 120 min of recovery (-36% from pre-exercise). CONCLUSION: Compared to highly trained ultra-endurance athletes consuming an HC diet, long-term keto-adaptation results in extraordinarily high rates of fat oxidation, whereas muscle glycogen utilization and repletion patterns during and after a 3 hour run are similar.

Effects of Three Oral Nutritional Supplements on Human Hydration Indices.

Urine color (Ucol) as a hydration assessment tool provides practicality, ease of use, and correlates moderately to strongly with urine specific gravity (Usg) and urine osmolality (Uosm). Indicative of daily fluid turnover, along with solute and urochrome excretion in 24-hr samples, Ucol may also reflect dietary composition. Thus, the purpose of this investigation was to determine the efficacy of Ucol as a hydration status biomarker after nutritional supplementation with beetroot (880 mg), vitamin C (1000 mg), and riboflavin (200 mg). Twenty males (Mean ± SD; age, 21 ± 2 y; body mass, 82.12 ± 15.58 kg; height, 1.77 ± 0.06 m) consumed a standardized breakfast and collected all urine voids on one control day (CON) and 1 day after consuming a standardized breakfast and a randomized and double-blinded supplement (SUP) over 3 weeks. Participants replicated exercise and diet for one day before CON, and throughout CON and SUP. Ucol, Usg, Uosm, and urine volume were measured in all 24-hr samples, and Ucol and Usg were measured in all single samples. Ucol was a significant predictor of single sample Usg after all supplements (p < .05). Interestingly, 24-hr Ucol was not a significant predictor of 24-h Usg and Uosm after riboflavin supplementation (p = .20, p = .21). Further, there was a significant difference between CON and SUP 24-h Ucol only after riboflavin supplementation (p < .05). In conclusion, this investigation suggests that users of the UCC (urine color chart) should consider riboflavin supplementation when classifying hydration status and use a combination of urinary biomarkers (e.g., Usg and Ucol), both acutely and over 24 hr.

An empirical method to determine inadequacy of dietary water.

OBJECTIVES: The physiological regulation of total body water and fluid concentrations is complex and dynamic. The human daily water requirement varies because of differences in body size, dietary solute load, exercise, and activities. Although chronically concentrated urine increases the risk of renal diseases, an empirical method to determine inadequate daily water consumption has not been described for any demographic group; instead, statistical analyses are applied to estimate nutritional guidelines (i.e., adequate intake). This investigation describes a novel empirical method to determine the 24-h total fluid intake (TFI; TFI = water + beverages + moisture in food) and 24-h urine volume, which correspond to inadequate 24-h water intake (defined as urine osmolality of 800 mOsm/kg; U800). METHODS: Healthy young women (mean ± standard deviation; age, 20 ± 2 y, mass, 60.8 ± 11.7 kg; n = 28) were observed for 7 consecutive days. A 24-h urine sample was analyzed for volume and osmolality. Diet records were analyzed to determine 24-h TFI. RESULTS: For these 28 healthy young women, the U800 corresponded to a TFI ≥2.4 L/d (≥39 mL/kg/d) and a urine volume ≥1.3 L/d. CONCLUSIONS: The U800 method could be employed to empirically determine 24-h TFI and 24-h urine volumes that correspond to inadequate water intake in diverse demographic groups, residents of specific geographic regions, and individuals who consume specialized diets or experience large daily water turnover. Because laboratory expertise and instrumentation are required, this technique provides greatest value in research and clinical settings.