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European Journal of Nutrition

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01-03-2019 | Review

Fluid balance and hydration status in combat sport Olympic athletes: a systematic review with meta-analysis of controlled and uncontrolled studies

Authors: Damir Zubac, Armin Paravlic, Reid Reale, Igor Jelaska, Shawnda A. Morrison, Vladimir Ivancev

Published in: European Journal of Nutrition | Issue 2/2019

Abstract

Purpose

Athletes in Olympic combat sports experience body water fluctuations resulting from training and intentional dehydration when making weight. Despite the popularity of urine specific gravity (U_SG) and urine osmolality (U_OSM) measurement in characterizing fluid fluctuations, their utility remains questioned. This systematic review/meta-analysis examined the utility of urinary hydration indices in laboratory and field settings in Olympic combat sport athletes.

Methods

27 articles met the inclusion criteria for systematic review, 15 studies were included in the meta-analysis; with U_SG and U_OSM the main outcome variables. Meta-regression analyses evaluated the interrelationship among body mass (B_M), fluid intake, and urine measures.

Results

Significant U_SG alterations were observed following different sampling time frames: dehydration (ES 0.59; 95% CI 0.46–0.72; p = 0.001), follow-up period (ES 0.31; 95% CI 0.11–0.50; p = 0.002) and rehydration (ES − 0.34; 95% CI − 0.56 to − 0.12; p = 0.003). Direct comparison of laboratory (ES 0.20; 95% CI − 0.19 to 0.59; p = 0.324) and field (ES 0.35; 95% CI 0.14–0.56; p = 0.001) sampling showed marginally trivial and small effects. Small effects on U_OSM were observed following dehydration (ES 0.31; 95% CI 0.12–0.74, p = 0.15), follow-up period (ES 0.39; 95% CI 0.08–0.70, p = 0.015) and rehydration (ES − 0.45; 95% CI − 0.60 to 0.30, p = 0.001). Meta-regression analysis suggests only fluid intake predicts U_SG alterations (p = 0.044) during rehydration protocols.

Conclusions

There were likely small changes in both U_SG and U_OSM readings across all experimental conditions, with moderate-to-large heterogeneity in all studies, except for U_SG readings during dehydration protocols. The meta-regression failed to provide conclusive evidence concerning the interrelationship among urine measures, B_M fluctuations, and fluid intake.

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Armstrong LE (2007) Assessing hydration status: the elusive gold standard. J Am Coll Nutr 26(sup5):575S–575S84SCrossRef

Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS (2007) Exercise and fluid replacement. Med Sci Sports Exerc 39(2):377–390. https://doi.org/10.1249/mss.0b013e31802ca597 CrossRefPubMed

Cheuvront SN, Kenefick RW (2014) Dehydration: physiology, assessment, and performance effects. Compr Physiol 4(1):257–285CrossRef

Guyton AC, Hall JE (2006) Textbook of medical physiology. Elsevier, Philadelphia

Zubac D, Reale R, Karnincic H, Sivric A, Jelaska I (2018) Urine specific gravity as an indicator of dehydration in Olympic combat sport athletes; considerations for research and practice. Eur J Sport Sci 18(7):920–929CrossRef

Reale R, Cox GR, Slater G, Burke LM (2016) Regain in body mass after weigh-in is linked to success in real life judo competition. Int J Sport Nutr Exerc Metab 26(6):525–530CrossRef

Reale R, Slater G, Burke LM (2017) Individualized dietary strategies for Olympic combat sports: acute weight loss, recovery and competition nutrition. Eur J Sport Sci 17(6):1–14CrossRef

Franchini E, Brito CJ, Artioli GG (2012) Weight loss in combat sports: physiological, psychological and performance effects. J Int Soc Sports Nutr 9(1):52–59CrossRef

Pettersson S, Berg CM (2014) Hydration status in elite wrestlers, judokas, boxers, and taekwondo athletes on competition day. Int J Sport Nutr Exerc Metab 24(3):267–275. https://doi.org/10.1123/ijsnem.2013-0100 CrossRefPubMed

10.

Loenneke JP, Wilson JM, Barnes JT, Pujol TJ (2011) Validity of the current NCAA minimum weight protocol: a brief review. Ann Nutr Metab 58(3):245–249CrossRef

11.

Oppliger RA, Steen SA, Scott JR (2003) Weight loss practices of college wrestlers. Int J Sport Nutr Exerc Metab 13(1):29–46CrossRef

12.

Nuccio RP, Barnes KA, Carter JM, Baker LB (2017) Fluid balance in team sport athletes and the effect of hypohydration on cognitive, technical, and physical performance. Sports Med 47(10):1951–1982CrossRef

13.

Arnaoutis G, Verginadis P, Seal AD, Vogiatzis I, Sidossis LS, Kavouras S (2018) Progressive dehydration in junior laser class sailors during world. Int J Sport Nutr Exerc Metab 28(1):75–81. https://doi.org/10.1123/ijsnem.2017-0142. (epub 2018 Jan 19) CrossRefPubMed

14.

Wilson G, Hawken MB, Poole I, Sparks A, Bennett S, Drust B, Morton J, Close GL (2014) Rapid weight-loss impairs simulated riding performance and strength in jockeys: implications for making-weight. J Sports Sci 32(4):383–391CrossRef

15.

Love TD, Baker DF, Healey P, Black KE (2018) Measured and perceived indices of fluid balance in professional athletes. The use and impact of hydration assessment strategies. Eur J Sport Sci 18(3):349–356CrossRef

16.

Zubac D, Antelj T, Olujic D, Ivančev V, Morrison SA (2017) Fluid balance and hydration assessment during the weight-stable preparation phase in elite youth boxers. J Sports Sci 35(8):719–726. https://doi.org/10.1080/02640414.2016.1184302 CrossRefPubMed

17.

Wilcoxson MS, Johnson SL, Pribyslavska V, Green JM, O’Neal EK (2017) Fluid retention and utility of practical hydration markers to detect three levels of recovery fluid intake in male runners. Int J Sport Nutr Exerc Metab 27(2):178–185CrossRef

18.

Cutrufello PT, Dixon CB (2014) The effect of acute fluid consumption following exercise-induced fluid loss on hydration status, percent body fat, and minimum wrestling weight in wrestlers. J Strength Cond Res 28(7):1928–1936CrossRef

19.

Buford TW, Rossi SJ, Smith DB, O’Brien MS, Pickering C (2006) The effect of a competitive wrestling season on body weight, hydration, and muscular performance in collegiate wrestlers. J Strength Cond Res 20(3):689–692PubMed

20.

20 Zubac D, Cular D, Marusic U (2018) Reliability of urinary dehydration markers in elite youth boxers. Int J Sports Physiol Perform 13(3):374–381CrossRef

21.

Singh NR, Peters EM (2013) Markers of hydration status in a 3-day trail running event. Clin J Sport Med 23(5):354–364CrossRef

22.

Hamouti N, Del Coso J, Avila A, Mora-Rodriguez R (2010) Effects of athletes’ muscle mass on urinary markers of hydration status. Eur J Appl Physiol 109(2):213–219. https://doi.org/10.1007/s00421-009-1333-x CrossRefPubMed

23.

Poortmans JR, Vanderstraeten J (1994) Kidney function during exercise in healthy and diseased humans. Sports Med 18(6):419–437CrossRef

24.

Martin WF, Cerundolo LH, Pikosky MA, Gaine PC, Maresh CM, Armstrong LE, Rodriguez NR (2006) Effects of dietary protein intake on indexes of hydration. J Am Diet Assoc 106(4):587–589CrossRef

25.

Gleim GW (2000) In chapter: Renal response to training and exercise: book exercise and sport science: Lippincott Williams & Wilkins, London, pp 221–222

26.

Costill DL, Sparks KE (1973) Rapid fluid replacement following thermal dehydration. J Appl Physiol 34(3):299–303CrossRef

27.

Stachenfeld NS (2014) The interrelationship of research in the laboratory and the field to assess hydration status and determine mechanisms involved in water regulation during physical activity. Sports Med 44(1):97–104CrossRef

28.

Cheuvront SN, Kenefick RW, Zambraski EJ (2015) Spot urine concentrations should not be used for hydration assessment: a methodology review. Int J Sport Nutr Exerc Metab 25(3):293–297. https://doi.org/10.1123/ijsnem.2014-0138 CrossRefPubMed

29.

Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83(8):713–721

30.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1–e34CrossRef

31.

Armstrong LE, Maughan RJ, Senay LC, Shirreffs SM (2013) Limitations to the use of plasma osmolality as a hydration biomarker. Am J Clin Nutr 98(2):503–504CrossRef

32.

Hamouti N, Del Coso J, Mora-Rodriguez R (2013) Comparison between blood and urinary fluid balance indices during dehydrating exercise and the subsequent hypohydration when fluid is not restored. Eur J Appl Physiol 113(3):611–620CrossRef

33.

Fernandez-Elias VE, Martinez-Abellan A, Lopez-Gullon JM, Moran-Navarro R, Pallares JG, De la Cruz-Sanchez E, Mora-Rodriguez R (2014) Validity of hydration non-invasive indices during the weight-cutting and official weigh-in for Olympic combat sports. PLoSOne 9(4):e95336. https://doi.org/10.1371/journal.pone.0095336 CrossRef

34.

Cochrane Consumers and Communication Group resources for authors (Internet) (2016) p 1. http://cccrg.cochrane.org/author-resources. Accessed 15 Feb 2017

35.

Manz F, Wentz A (2003) 24-h hydration status: parameters, epidemiology and recommendations. Eur J Clin Nutr 57(S2):S10CrossRef

36.

Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ Br Med J 327(7414):557–560CrossRef

37.

Hedges LV (1981) Distribution theory for Glass’s estimator of effect size and related estimators. J Educ Stat 6(2):107–128CrossRef

38.

Savoie FA, Kenefick RW, Ely BR, Cheuvront SN, Goulet ED (2015) Effect of hypohydration on muscle endurance, strength, anaerobic power and capacity and vertical jumping ability: a meta-analysis. Sports Med 45(8):1207–1227CrossRef

39.

Hopkins WG, Marshall SW, Batterham AM, Hanin J (2009) Progressive statistics for studies in sports medicine and exercise science. Med Sci Sports Exerc 41(1):3–12CrossRef

40.

Pallarés JG, Martínez-Abellán A, López-Gullón JM, Morán-Navarro R, De la Cruz-Sánchez E, Mora-Rodríguez R (2016) Muscle contraction velocity, strength and power output changes following different degrees of hypohydration in competitive Olympic combat sports. J Int Soc Sports Nutr 13(1):10CrossRef

41.

Ratamess NA, Hoffman JR, Kraemer WJ, Ross RE, Tranchina CP, Rashti SL, Kelly NA, Vingren JL, Kang J, Faigenbaum AD (2013) Effects of a competitive wrestling season on body composition, endocrine markers, and anaerobic exercise performance in NCAA collegiate wrestlers. Eur J Appl Physiol 113(5):1157–1168CrossRef

42.

Rivera-Brown AM, De Félix-Dávila RA (2012) Hydration status in adolescent judo athletes before and after training in the heat. Int J Sports Physiol Perform 7:39–46CrossRef

43.

Cheuvront SN, Carter R, Carter SJ, Montain SJ, Sawka MN (2004) Daily body mass variability and stability in active men undergoing exercise-heat stress. Int J Sport Nutr Exerc Metab 14(5):532–540CrossRef

44.

King C, Cooke S, Carroll, O’Hara J (2008) Estimating changes in hydration status from changes in body mass: considerations regarding metabolic water and glycogen storage. J Sports Sci 26(12):1361–1363CrossRef

45.

Maughan JR, Shirreffs SM, Leiper JB (2007) Errors in the estimation of hydration status from changes in body mass. J Sports Sci 25(7):797–804CrossRef

46.

Perrier ET (2017) Shifting focus: from hydration for performance to hydration for health. Ann Nutr Metab 70(Suppl. 1):4–12CrossRef

47.

Robertson GL, Mahr EA, Athar S, Sinha T (1973) Development and clinical application of a new method for the radioimmunoassay of arginine vasopressin in human plasma. J Clin Invest 52:2340–2352CrossRef

48.

Bartok C, Schoeller DA, Sullivan JC, Clark RR, Landry GL (2004) Hydration testing in collegiate wrestlers undergoing hypertonic dehydration. Med Sci Sports Exerc 36(3):510–517CrossRef

49.

Cutrufello PT, Dixon CB (2013) The effect of acute fluid consumption and hydration status on percent body fat and minimum wrestling weight. J Strength Cond Res 27(7):1950–1957CrossRef

50.

Gonçalves EM, Matias CN, Santos DA, Sardinha LB, Silva AM (2016) Assessment of total body water and its compartments in elite judo athletes: comparison of bioelectrical impedance spectroscopy with dilution techniques. J Sports Sci 33(6):634–640CrossRef

51.

Kutlu M, Guler G (2006) Assessment of hydration status by urinary analysis of elite junior Taekwon-do athletes in preparing for competition. J Sports Sci 24(8):869–873CrossRef

52.

Kutlu M, Demirkan E, Özbek, ME (2015) Assessments of world and national level wrestling teams at a pre-world championship competition: hydration, body composition and body mass alterations. J Sports Med Phys Fitness 55(4):305–312PubMed

53.

Lingor RJ, Olson A (2010) Fluid and diet patterns associated with weight cycling and changes in body composition assessed by continuous monitoring throughout a college wrestling season. J Strength Cond Res 24(7):1763–1772CrossRef

54.

Ööpik V, Timpmann S, Burk A, Hannus I (2013) Hydration status of Greco-Roman wrestlers in an authentic pre-competition situation. Appl Physiol Nutr Metab 38(6):621–625CrossRef

55.

Oppliger RA, Magnes SA, Popowski LA, Gisolfi CV (2005) Accuracy of urine specific gravity and osmolality as indicators of hydration status. Int J Sport Nutr Exerc Metab 15(3):236–251CrossRef

56.

Shirreffs SM, Maughan RJ (1998) Urine osmolality and conductivity as indices of hydration status in athletes in the heat. Med Sci Sports Exerc 30(11):1598–1602CrossRef

57.

Stuempfle KJ, Drury DG (2003) Comparison of 3 methods to assess urine specific gravity in collegiate wrestlers. J Athl Train 38(4):315PubMedPubMedCentral

58.

Sommerfield LM, McAnulty SR, McBride JM, Zwetsloot JJ, Austin MD, Mehlhorn JD, Utter AC (2016) Validity of urine specific gravity when compared with plasma osmolality as a measure of hydration status in male and female NCAA collegiate athletes. J Strength Cond Res 30(8):2219–2225CrossRef

59.

Utter AC, McAnulty SR, Sarvazyan A, Query MC, Landram MJ (2010) Evaluation of ultrasound velocity to assess the hydration status of wrestlers. J Strength Cond Res 24(6):1451–1457CrossRef

60.

Utter AC, Quindry JC, Emerenziani GP, Valiente JS (2010) Effects of rooibos tea, bottled water, and a carbohydrate beverage on blood and urinary measures of hydration after acute dehydration. Res Sports Med 18(2):85–96CrossRef

61.

Utter AC, McAnulty SR, Riha BF, Pratt BA, Grose JM (2012) The validity of multifrequency bioelectrical impedance measures to detect changes in the hydration status of wrestlers during acute dehydration and rehydration. J Strength Cond Res 26(1):9–15. https://doi.org/10.1519/JSC.0b013e318238ea51 CrossRefPubMed

62.

Valiente JS, Utter AC, Quindry JC, Nieman DC (2009) Effects of commercially formulated water on the hydration status of dehydrated collegiate wrestlers. J Strength Cond Res 23(8):2210–2216CrossRef

63.

Zubac D, Karnincic H, Zaja M (2016) Hydration status assessment among elite youth amateur boxers. J Sports Med Phys Fitness 56(6):731–736PubMed

64.

Yamashita N, Ito R, Nakano M, Matsumoto T (2015) Two percent hypohydration does not impair self-selected high-intensity intermittent exercise performance. J Strength Cond Res 29(1):116–125CrossRef

65.

Weber AF, Mihalik JP, Register-Mihalik JK, Mays S, Prentice WE, Guskiewicz KM (2013) Dehydration and performance on clinical concussion measures in collegiate wrestlers. J Athl Train 48(2):153–160CrossRef

66.

Cheuvront SN, Ely BR, Kenefick RW, Sawka MN (2010) Biological variation and diagnostic accuracy of dehydration assessment markers. J Am Coll Nutr 92(3):565–573CrossRef

67.

Nose HI, Mack GW, Shi XR, Nadel ER (1998) Role of osmolality and plasma volume during rehydration in humans. J Appl Physiol 65(1):325–331CrossRef

68.

Krüger M, Linke WA (2011) The giant protein titin: a regulatory node that integrates myocyte signaling pathways. J Biol Chem 286(12):9905–9912CrossRef

69.

Kanda K, Sakuma J, Akimoto T, Kawakami Y, Suzuki K (2017) Detection of titin fragments in urine in response to exercise-induced muscle damage. PloS One 12(7):e0181623CrossRef

70.

Şentürk ÜK, Kuru O, Koçer G, &Gündüz F (2007) Biphasic pattern of exercise-induced proteinuria in sedentary and trained men. Nephron Physiol 105(2):p22–p32CrossRef

71.

Arnaoutis G, Kavouras SA, Angelopoulou A, Skoulariki C, Bismpikou S, Mourtakos S, Sidossis LS (2015) Fluid balance during training in elite young athletes of different sports. J Strength Cond Res 29(12):3447CrossRef

72.

Reljic D, Feist J, Jost J, Kieser M, Friedmann-Bette B (2015) Rapid body mass loss affects erythropoiesis and hemolysis but does not impair aerobic performance in combat athletes. Scand J Med Sci Sports. https://doi.org/10.1111/sms.12485 CrossRefPubMed

73.

Figaro MK, Mack GW (1997) Regulation of fluid intake in dehydrated humans: role of oropharyngeal stimulation. Am J Physiol Regul Integr Comp Physiol 272(6):R1740–R1746CrossRef

74.

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomized trials. BMJ 343d5928

75.

Reale R, Slater G, Burke LM (2018) Weight management practices of Australian Olympic combat sport athletes. Int J Sports Physiol Perform 13(4):459–466CrossRef

Title: Fluid balance and hydration status in combat sport Olympic athletes: a systematic review with meta-analysis of controlled and uncontrolled studies
Authors: Damir Zubac
Armin Paravlic
Reid Reale
Igor Jelaska
Shawnda A. Morrison
Vladimir Ivancev
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Nutrition / Issue 2/2019
Print ISSN: 1436-6207
Electronic ISSN: 1436-6215
DOI: https://doi.org/10.1007/s00394-019-01937-2

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