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Hydration and Fluid Balance Hydration and fluid balance: Studies on body composition, drink formulation and ageing By NIDIA RODRIGUEZ-SANCHEZ A thesis submitted to the University of Stirling in partial fulfilment for the degree of Doctor of Philosophy Physiology, Exercise and Nutrition Research Group Faculty of Health Sciences and Sport November 2016 “Above all, don't fear difficult moments. The best comes from them." Rita Levi-Montalcini Declaration I declare that this thesis was composed by myself and that all the data were collected and analysed by myself except part of the data presented in Chapters 4 (Part A) and 5 that were part of a multicentre project where Philip AA Cordery under the supervision of Phillip Watson and Ronald J Maughan from Loughborough University and Alberto Dolci and Samuel J Oliver under the supervision of Neil P Walsh from Bangor University performed the data collection and sample analysis in their respective locations. Neither the thesis nor the original work has been submitted to this or any other institution for a higher degree. Nidia Rodriguez Sanchez (10/11/16) “The copyright of this thesis belongs to the author, under the terms of the United Kingdom copyright act, as qualified by the University of Stirling regulations. Due acknowledgement must always be made of the use of any material contained in, or derived from this thesis.” Thank you… Nidia Rodriguez-Sanchez, Ph.D. Thesis THANK YOU… First of all, thank you to Dr Stuart Galloway who, since I first showed my interest in coming to Stirling, was very kind and helped to make my arrival and first few days at Stirling easier. Thanks for being really supportive during the entire Ph.D. journey, and always being there in the early morning trials, teaching me in the lab and going through all the writing process with me. It has been such a privilege to work alongside you. I have learned so much from you. Thank you for giving me the opportunity to pursue my Ph.D. under your supervision. Thank you very much to all the members of Physiology, Exercise & Nutrition Research Group, Kevin, for all your support since we met in Mexico in October 2012, for all your support when I arrived at Stirling and during my Ph.D. Ian W, Olly, Naomi, Iain G, thank you for your help during my trials. Gill and Chris, thank you very much for all your help in the lab and in the panic moments. Thank you for sharing lots of cups of tea and cake! Gill, thank you for all those ELISA, iLab and freezer moments of fun. Chris, thank you for all your patience and support in the lab. Sophie, Lindsay, Chris M, Mike, Lewis, Tom, Adam, Andy, thank you very much for helping me too when I was running my trials, getting some pilot data or practising some of the skills that I acquired during my Ph.D. (a.k.a. Blood club!). Colin and Jordan, thanks for making the 3A57 a great place to be! Barbara, Gill, Lindsay, Roslyn, Naomi and Sophie, thank you for your friendship, for all the teas, coffees, cakes, pancakes, dinners and all the lovely moments we have shared. Abstract Nidia Rodriguez-Sanchez, Ph.D. Thesis Thank you to my friends back in Mexico, Ingrid, Marthita, Adri and Sam, thanks for always being there for me regardless of the time or distance. Gracias Papá por siempre apoyarme en mis decisiones y ayudarme a realizar mis sueños. Gracias Mamá por tu apoyo y por siempre estar, por escucharme y por las palabras de aliento. Gracias por ser mis papás, los quiero mucho. Thank you to Alistair for your continued love, patience and belief in me. You have made this journey a much happier one for me. I love you so much. Thank you to all my participants, without you this thesis would not be possible. Thank you for all your time, your enthusiasm and your altruistic willingness to help to develop science. I will always be indebted to you. To my family and all my friends in Scotland and in Mexico, thanks for all your love and support and for believing in me! 2 Abstract Nidia Rodriguez-Sanchez, Ph.D. Thesis Abstract The thesis reports on 6 studies (2 of which were part of a multi-centre trial) examining hydration and fluid balance. The first study described in this thesis investigated the impact of hydration status on Dual energy x-ray absorptiometry (DXA) and other methods that are popular tools to determine body composition in athletes. We observed that it is important to ensure a euhydration when assessing body composition, particularly when considering changes associated with nutritional or exercise interventions. The second and third studies reported identified beverages that promote longer term fluid retention and maintenance of fluid balance in adults. We investigated the effects of 13 different commonly consumed drinks on urine output and fluid balance when ingested in a euhydrated state, with a view to establishing a beverage hydration index (BHI), i.e., the volume of urine produced after drinking expressed relative to a standard treatment (still water) for each beverage. The beverages with the highest BHI were oral rehydration solution, full fat milk and skimmed milk. BHI may be a useful measure to identify the short term hydration potential of different beverages when ingested in a euhydrated state. The fourth study aimed to systematically examine the influence of carbohydrate, sodium and caffeine content of beverages on the BHI. The BHI was greater in beverages with higher carbohydrate or higher sodium content, but not influenced by caffeine. The carbohydrate content of beverages has no effect on BHI at concentration up to 10% carbohydrate. Sodium content of beverages in concentrations of 27mmol/L and higher can improve the hydration potential of beverages. Caffeine doses in beverages up to 400mg/L do not have an impact upon diuresis when ingested in a euhydrated state. The fifth study compared net fluid balance (NFB) responses to the ingestion of commonly consumed drinks in young and older men. We observed that in young adults milk helps to maintain positive net fluid balance for longer than other drinks. In older adults this effect of milk is not observed despite similar net electrolyte balance responses. Future work should more fully explore these potential differences in fluid balance responses to drink ingestion between young and older adults. I Abstract Nidia Rodriguez-Sanchez, Ph.D. Thesis The final study investigated the hydration habits of Scottish young and older adults (+50 years old), identifying their fluid choices, volume, and preferences in relation to time of day. The results showed that 26.1% of the young females, 30.3% of the young males, 25.8% of the older females and 50.4% of the older males did not meet the EFSA fluid recommendations. We also observed that the difference between those who met and those who did not meet the EFSA adequate intake could be attributed to differences in water ingestion, mainly during the mid-morning (after breakfast until 11 am) and during the early-afternoon (after lunch time up to 5 pm). It was concluded that these moments might be key when implementing interventions to improve hydration status especially in the older population. II Table of Contents Nidia Rodriguez-Sanchez, Ph.D. Thesis Table of Contents Abstract .............................................................................................................................................................. I Table of Contents ............................................................................................................................................ i List of publications ..................................................................................................................................... vii List of abbreviations ................................................................................................................................... ix LITERATURE REVIEW ........................................................................................................ 1 1.1 Introduction ...................................................................................................................................... 1 1.1.1 What controls hydration/fluid balance? ..................................................................... 1 1.1.2 Assessment of hydration status ...................................................................................... 5 1.1.3 Importance of hydration ................................................................................................. 12 1.3.1 Energy/macronutrient content of drinks and hydration .................................. 17 1.3.2 Electrolyte content of drinks and effective hydration ........................................ 29 1.4 Summary ................................................................................................................................................ 43 1.4.2 During exercise ................................................................................................................... 44 1.4.3 Recovery from exercise ................................................................................................... 45 1.4.4 Other considerations ........................................................................................................ 46 Hydration in the older adults ........................................................................................................... 46 Hydration in the female adults ........................................................................................................ 54 1.5 Conclusions ..........................................................................................................................................
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