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Associations of Urine Specific Gravity With Body Mass Index and Lean Body Mass at the Population Level: Implications for Hydration Monitoring

Patrick B. Wilson

Urine specific gravity (USG) thresholds are used in practice and research to determine hypohydration. However, some limited research has found that body size and body composition may impact USG, suggesting that fixed cutoffs may be insensitive. Cross-sectional data from 3,634 participants of the 2007–2008 National Health and Nutrition Examination Survey were analyzed. Along with USG, body mass index (BMI), estimated lean body mass (LBM), and dietary intake were quantified. Logistic regression models were used to evaluate whether higher quintiles of BMI and LBM were associated with elevated USG (USG ≥ 1.020 and ≥1.025) after accounting for dietary moisture and sodium. The USG (1.018 ± 0.0003 vs. 1.015 ± 0.0004); BMI (28.4 ± 0.2 vs. 28.0 ± 0.2 kg/m2); LBM (60.9 ± 0.3 vs. 42.2 ± 0.2 kg); dietary moisture (3,401 ± 92 vs. 2,759 ± 49 g/day); and dietary sodium (4,171 ± 85 vs. 2,959 ± 50) were greater in men than in women (p < .05). Men and women in the fifth quintiles of BMI or LBM (vs. Quintile 1) had greater odds (2.00–3.68, p < .05) of elevated USG. (The only exception was for the association between BMI and USG ≥ 1.025 in men.) Being in Quintile 4 of LBM or BMI (vs. Quintile 1) also tended to be associated with higher odds of elevated of USG, though this pattern was more consistent when using USG ≥ 1.020 than USG ≥ 1.025. In summary, BMI and LBM are associated with USG at the population level. These results affirm that USG depends on body size and composition and raise questions about using fixed USG thresholds for determining hypohydration, particularly for people in the upper quintiles of BMI and LBM.

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Increased Performance in Elite Runners Following Individualized Timing of Sodium Bicarbonate Supplementation

Tue A.H. Lassen, Lars Lindstrøm, Simon Lønbro, and Klavs Madsen

The present study investigated individualized sodium bicarbonate (NaHCO3 ) supplementation in elite orienteers and its effects on alkalosis and performance in a simulated sprint orienteering competition. Twenty-one Danish male and female elite orienteers (age = 25.2 ± 3.6 years, height = 176.4 ± 10.9 cm, body mass = 66.6 ± 7.9 kg) were tested twice in order to identify individual time to peak blood bicarbonate (HCO3 peak) following supplementation of 0.3 g/kg body mass NaHCO3 with and without warm-up. The athletes also performed two 3.5 km time-trial runs (TT-runs) following individualized timing of NaHCO3 supplementation (SBS) or placebo (PLA) on separate days in a randomized, double-blind, cross-over design. The occurrence of individual peak HCO3 and pH ranged from 60 to 180 min. Mean HCO3 and pH in SBS were significantly higher compared with PLA 10 min before and following the TT-run (p < .01). SBS improved overall performance in the 3.5 km TT-run by 6 s compared with PLA (775.5 ± 16.2 s vs. 781.4 ± 16.1 s, respectively; p < .05). SBS improved performance in the last half of the TT-run compared with PLA (p < .01). In conclusion, supplementation with NaHCO3 followed by warm-up resulted in individualized alkalosis peaks ranging from 60 to 180 min. Individualized timing of SBS in elite orienteers induced significant alkalosis before and after a 3.5 km TT and improved overall performance time by 6 s, which occurred in the last half of the time trial. The present data show that the anaerobic buffer system is important for performance in these types of endurance events lasting 12–15 min.

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Volume 31 (2021): Issue 5 (Sep 2021)

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Carbohydrate and Protein Co-Ingestion Postexercise Does Not Improve Next-Day Performance in Trained Cyclists

Hilkka Kontro, Marta Kozior, Gráinne Whelehan, Miryam Amigo-Benavent, Catherine Norton, Brian P. Carson, and Phil Jakeman

Supplementing postexercise carbohydrate (CHO) intake with protein has been suggested to enhance recovery from endurance exercise. The aim of this study was to investigate whether adding protein to the recovery drink can improve 24-hr recovery when CHO intake is suboptimal. In a double-blind crossover design, 12 trained men performed three 2-day trials consisting of constant-load exercise to reduce glycogen on Day 1, followed by ingestion of a CHO drink (1.2 g·kg−1·2 hr−1) either without or with added whey protein concentrate (CHO + PRO) or whey protein hydrolysate (CHO + PROH) (0.3 g·kg−1·2 hr−1). Arterialized blood glucose and insulin responses were analyzed for 2 hr postingestion. Time-trial performance was measured the next day after another bout of glycogen-reducing exercise. The 30-min time-trial performance did not differ between the three trials (M ± SD, 401 ± 75, 411 ± 80, 404 ± 58 kJ in CHO, CHO + PRO, and CHO + PROH, respectively, p = .83). No significant differences were found in glucose disposal (area under the curve [AUC]) between the postexercise conditions (364 ± 107, 341 ± 76, and 330 ± 147, mmol·L−1·2 hr−1, respectively). Insulin AUC was lower in CHO (18.1 ± 7.7 nmol·L−1·2 hr−1) compared with CHO + PRO and CHO + PROH (24.6 ± 12.4 vs. 24.5 ± 10.6, p = .036 and .015). No difference in insulin AUC was found between CHO + PRO and CHO + PROH. Despite a higher acute insulin response, adding protein to a CHO-based recovery drink after a prolonged, high-intensity exercise bout did not change next-day exercise capacity when overall 24-hr macronutrient and caloric intake was controlled.

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Exercise and Heat Stress: Inflammation and the Iron Regulatory Response

Alannah K.A. McKay, Rachel McCormick, Nicolin Tee, and Peter Peeling

This study determined the impact of heat stress on postexercise inflammation and hepcidin levels. Twelve moderately trained males completed three, 60-min treadmill running sessions under different conditions: (a) COOL, 18 °C with speed maintained at 80% maximum heart rate; (b) HOTHR, 35 °C with speed maintained at 80% maximum heart rate; and (c) HOTPACE, 35 °C completed at the average running speed from the COOL trial. Venous blood samples were collected pre-, post-, and 3-hr postexercise and analyzed for serum ferritin, interleukin-6 (IL-6), and hepcidin concentrations. Average HR was highest during HOTPACE compared with HOTHR and COOL (p < .001). Running speed was slowest in HOTHR compared with COOL and HOTPACE (p < .001). The postexercise increase in IL-6 was greatest during HOTPACE (295%; p = .003). No differences in the IL-6 response immediately postexercise between COOL (115%) and HOTHR (116%) were evident (p = .992). No differences in hepcidin concentrations between the three trials were evident at 3 hr postexercise (p = .407). Findings from this study suggest the IL-6 response to exercise is greatest in hot compared with cool conditions when the absolute running speed was matched. No differences in IL-6 between hot and cool conditions were evident when HR was matched, suggesting the increased physiological strain induced from training at higher intensities in hot environments, rather than the heat per se, is likely responsible for this elevated response. Environmental temperature had no impact on hepcidin levels, indicating that exercising in hot conditions is unlikely to further impact transient alterations in iron regulation, beyond that expected in temperate conditions.

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Caffeine Mouth Rinse Does Not Improve Time to Exhaustion in Male Trained Cyclists

Lara Lima Nabuco, Bryan Saunders, Renato André Sousa da Silva, Guilherme Eckhardt Molina, and Caio Eduardo Gonçalves Reis

This study investigated the effects of caffeine mouth rinse on cycling time to exhaustion (TTE) and physiological responses in trained cyclists. In a double-blinded randomized counterbalanced cross-over design, 10 recreationally trained male cyclists (mean ± SD: 32 ± 3 years, 72.8 ± 5.3 kg, 1.78 ± 0.06 m, 13.9% ± 3.3% body fat, peak power output = 289.4 ± 24.7 W) completed two TTE tests cycling at 75% of peak aerobic power following 24 hr of dietary and exercise standardization. Cyclists were administered 25-ml mouth rinses for 5 s containing either 85 mg of caffeine or control (water) every 5 min throughout the exercise tests. No significant improvement in TTE was shown with caffeine mouth rinse compared with control (33:24 ± 12:47 vs. 28:08 ± 10:18 min; Cohen’s dz effect size: 0.51, p = .14). Caffeine mouth rinse had no significant effect on ratings of perceived exertion (p = .31) or heart rate (p = .35) throughout the cycling TTE protocol. These data indicate that a repeated dose of caffeinated mouth rinse for 5 s does not improve cycling TTE in recreationally trained male cyclists. However, these findings should be taken with caution due to the small sample size and blinding ineffectiveness, while further well-design studies with larger samples are warranted.

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Changes in Hydration Factors Over the Course of Heat Acclimation in Endurance Athletes

Yasuki Sekiguchi, Courteney L. Benjamin, Samantha O. Dion, Ciara N. Manning, Jeb F. Struder, Erin E. Dierickx, Margaret C. Morrissey, Erica M. Filep, and Douglas J. Casa

The purpose of this study was to examine the effect of heat acclimation (HA) on thirst levels, sweat rate, and percentage of body mass loss (%BML), and changes in fluid intake factors throughout HA induction. Twenty-eight male endurance athletes (mean ± SD; age, 35 ± 12 years; body mass, 73.0 ± 8.9 kg; maximal oxygen consumption, 57.4 ± 6.8 ml·kg−1·min−1) completed 60 min of exercise in a euhydrated state at 58.9 ± 2.3% velocity of maximal oxygen consumption in the heat (ambient temperature, 35.0 ± 1.3 °C; relative humidity, 48.0 ± 1.3%) prior to and following HA where thirst levels, sweat rate, and %BML were measured. Then, participants performed 5 days of HA while held at hyperthermia (38.50–39.75 °C) for 60 min with fluid provided ad libitum. Sweat volume, %BML, thirst levels, and fluid intake were measured for each session. Thirst levels were significantly lower following HA (pre, 4 ± 1; post, 3 ± 1, p < .001). Sweat rate (pre, 1.76 ± 0.42 L/hr; post, 2.00 ± 0.60 L/hr, p = .039) and %BML (pre, 2.66 ± 0.53%; post, 2.98 ± 0.83%, p = .049) were significantly greater following HA. During HA, thirst levels decreased (Day 1, 4 ± 1; Day 2, 3 ± 2; Day 3, 3 ± 2; Day 4, 3 ± 1; Day 5, 3 ± 1; p < .001). However, sweat volume (Day 1, 2.34 ± 0.67 L; Day 2, 2.49 ± 0.58 L; Day 3, 2.67 ± 0.63 L; Day 4, 2.74 ± 0.61 L; Day 5, 2.74 ± 0.91 L; p = .010) and fluid intake (Day 1, 1.20 ± 0.45 L; Day 2, 1.52 ± 0.58 L; Day 3, 1.69 ± 0.63 L; Day 4, 1.65 ± 0.58 L; Day 5, 1.74 ± 0.51 L; p < .001) increased. In conclusion, thirst levels were lower following HA even though sweat rate and %BML were higher. Thirst levels decreased while sweat volume and fluid intake increased during HA induction. Thus, HA should be one of the factors to consider when planning hydration strategies.

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Implication of Blood Rheology and Pulmonary Hemodynamics on Exercise-Induced Hypoxemia at Sea Level and Altitude in Athletes

Antoine Raberin, Elie Nader, Jorge Lopez Ayerbe, Patrick Mucci, Vincent Pialoux, Henri Meric, Philippe Connes, and Fabienne Durand

This study aimed to investigate the changes in blood viscosity, pulmonary hemodynamics, nitric oxide (NO) production, and maximal oxygen uptake ( V ˙ O 2 max ) during a maximal incremental test conducted in normoxia and during exposure to moderate altitude (2,400 m) in athletes exhibiting exercise-induced hypoxemia at sea level (EIH). Nine endurance athletes with EIH and eight without EIH (NEIH) performed a maximal incremental test under three conditions: sea level, 1 day after arrival in hypoxia, and 5 days after arrival in hypoxia (H5) at 2,400 m. Gas exchange and oxygen peripheral saturation (SpO2) were continuously monitored. Cardiac output, pulmonary arterial pressure, and total pulmonary vascular resistance were assessed by echocardiography. Venous blood was sampled before and 3 min after exercise cessation to analyze blood viscosity and NO end-products. At sea level, athletes with EIH exhibited an increase in blood viscosity and NO levels during exercise while NEIH athletes showed no change. Pulmonary hemodynamics and aerobic performance were not different between the two groups. No between-group differences in blood viscosity, pulmonary hemodynamics, and V ˙ O 2 max were found at 1 day after arrival in hypoxia. At H5, lower total pulmonary vascular resistance and greater NO concentration were reported in response to exercise in EIH compared with NEIH athletes. EIH athletes had greater cardiac output and lower SpO2 at maximal exercise in H5, but no between-group differences occurred regarding blood viscosity and V ˙ O 2 max . The pulmonary vascular response observed at H5 in EIH athletes may be involved in the greater cardiac output of EIH group and counterbalanced the drop in SpO2 in order to achieve similar V ˙ O 2 max than NEIH athletes.

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Acute Effects of Dietary Nitrate on Exercise Tolerance, Muscle Oxygenation, and Cardiovascular Function in Patients With Peripheral Arterial Disease

Cindy M.T. van der Avoort, Luc J.C. van Loon, Lex B. Verdijk, Paul P.C. Poyck, Dick T.J. Thijssen, and Maria T.E. Hopman

Previous studies have used supplements to increase dietary nitrate intake in clinical populations. Little is known about whether effects can also be induced through vegetable consumption. Therefore, the aim of this study was to assess the impact of dietary nitrate, through nitrate-rich vegetables (NRV) and beetroot juice (BRJ) supplementation, on plasma nitrate and nitrite concentrations, exercise tolerance, muscle oxygenation, and cardiovascular function in patients with peripheral arterial disease. In a randomized crossover design, 18 patients with peripheral arterial disease (age: 73 ± 8 years) followed a nitrate intake protocol (∼6.5 mmol) through the consumption of NRV, BRJ, and nitrate-depleted BRJ (placebo). Blood samples were taken, blood pressure and arterial stiffness were measured in fasted state and 150 min after intervention. Each intervention was followed by a maximal walking exercise test to determine claudication onset time and peak walking time. Gastrocnemius oxygenation was measured by near-infrared spectroscopy. Blood samples were taken and blood pressure was measured 10 min after exercise. Mean plasma nitrate and nitrite concentrations increased (nitrate; Time × Intervention interaction; p < .001), with the highest concentrations after BRJ (494 ± 110 μmol/L) compared with NRV (202 ± 89 μmol/L) and placebo (80 ± 19 μmol/L; p < .001). Mean claudication onset time and peak walking time did not differ between NRV (413 ± 187 s and 745 ± 220 s, respectively), BRJ (392 ± 154 s and 746 ± 176 s), and placebo (403 ± 176 s and 696 ± 222 s) (p = .762 and p = .165, respectively). Gastrocnemius oxygenation, blood pressure, and arterial stiffness were not affected by the intervention. NRV and BRJ intake markedly increase plasma nitrate and nitrite, but this does not translate to improved exercise tolerance, muscle oxygenation, and/or cardiovascular function.

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CYP1A2 Genotype Modifies the Effects of Caffeine Compared With Placebo on Muscle Strength in Competitive Male Athletes

Oriana Wong, Keiko Marshall, Marc Sicova, Nanci S. Guest, Bibiana García-Bailo, and Ahmed El-Sohemy

Caffeine is commonly used to improve athletic performance across a variety of sports. Previously, the CYP1A2 gene has been shown to modify the effects of caffeine on endurance performance. The effect of caffeine on strength and power activities is unclear and may differ depending on an individual’s CYP1A2 genotype. A randomized controlled trial was used to determine whether caffeine impacts strength and power, determined by the handgrip and vertical jump tests, respectively, and whether CYP1A2 genotype modifies any effects. Competitive male athletes (age = 25 ± 4 years) completed vertical jump (n = 97), and handgrip tests (n = 102) under three conditions: 0 (placebo), 2, or 4 mg of caffeine per kilogram of body mass (in milligrams per kilogram). CYP1A2 (rs762551) genotype was determined from saliva samples. No differences between caffeine doses and placebo were observed for strength or power; however, significant Caffeine × Gene interactions were observed for all exercise tests. Individuals with the CC genotype experienced a 12.8% decrease in handgrip strength with 4 mg/kg of caffeine compared with placebo (53 ± 11 kg vs. 61 ± 17 kg, p = .02). No differences were observed in those with the AC or AA genotypes. Despite observing a significant Caffeine × Gene interaction for vertical jump performance, no differences were observed between caffeine doses and placebo for all genotypes. In summary, caffeine (4 mg/kg) worsened handgrip strength performance in those with the CC genotype, but no differences were observed in those with the AC or AA genotypes. Athletes may want to consider their CYP1A2 genotype prior to using caffeine to improve muscle strength.