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Biological variation and diagnostic accuracy of dehydration assessment markers
Open accessAbstract
Background Well-recognized markers for static (one time) or dynamic (monitoring over time) dehydration assessment have not been rigorously tested for their usefulness in clinical, military, and sports medicine communities. Objective This study evaluated the components of biological variation and the accuracy of potential markers in plasma, urine, saliva, and body mass (B(m)) for static and dynamic dehydration assessment. Design We studied 18 healthy volunteers (13 men and 5 women) while carefully controlling hydration and numerous preanalytic factors. Biological variation was determined over 3 consecutive days by using published methods. Atypical values based on statistical deviations from a homeostatic set point were examined. Measured deviations in body fluid were produced by using a separate, prospective dehydration experiment and evaluated by receiver operating characteristic (ROC) analysis to quantify diagnostic accuracy. Results All dehydration markers displayed substantial individuality and one-half of the dehydration markers displayed marked heterogeneity of intraindividual variation. Decision levels for all dehydration markers were within one SD of the ROC criterion values, and most levels were nearly identical to the prospective group means after volunteers were dehydrated by 1.8-7.0% of B(m). However, only plasma osmolality (P(osm)) showed statistical promise for use in the static dehydration assessment. A diagnostic decision level of 301 plusmn 5 mmol/kg was propo…
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“When we take in too little fluid (drink too little) the fluid within and around our cells becomes more concentrated, raising the osmolality of serum and plasma (221)(222)(223)(224).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [221]
In the citing paper
“Their suggested threshold is that serum or plasma osmolality >300 mOsm/kg is classified as dehydrated.”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [221]
In the citing paper
“They assessed the range of plasma osmolality in hydrated younger adults, then in the same persons who had been dehydrated, identifying the cut-off that best separated the two states.”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [221]
In the citing paper
“Volume depletion (reduced volume of extracellular fluids only, due to loss of fluids and electrolytes, also called salt loss or extracellular dehydration) occurs without raised serum or plasma osmolality”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [221]
In the citing paper
“Threshold values of serum osmolality have been assessed in varied ways, but Cheuvront et al. (221) appear to have developed these most rigorously.”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [221]
In the citing paper
“and following medical conditions resulting in excessive losses of fluid and electrolytes, such as excessive blood loss, vomiting, and diarrhea (221-224).”
From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [221]
Citations
Cites
Hanley, J. A., & McNeil, B. J. (1983) · Radiology · doi:10.1148/radiology.148.3.6878708 · Cited by 7,016
Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine
ZWEIG, M. H., & Campbell, G. (1993) · Clinical Chemistry · doi:10.1093/clinchem/39.4.561 · Cited by 6,595
American College of Sports Medicine position stand
Otis, C. L. (1997) · Medical Entomology and Zoology · Cited by 4,407
ACSM Position Stand: Exercise and Fluid Replacement
Convertino, V. A., Armstrong, L. E., Coyle, E. F., Mack, G. W., Sawka, M. N., Senay, L. C., & Sherman, W. M. (1996) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199610000-00045 · Cited by 1,977
Self-citationExercise and Fluid Replacement
(2007) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31802ca597 · Cited by 1,497
Self-citationCurrent databases on biological variation: pros, cons and progress
C. Ricós, V. A. (1999) · Scandinavian Journal of Clinical and Laboratory Investigation · doi:10.1080/00365519950185229 · Cited by 987
Generation and Application of Data on Biological Variation in Clinical Chemistry
Fraser, G. G., & Harris, E. K. (1989) · Critical Reviews in Clinical Laboratory Sciences · doi:10.3109/10408368909106595 · Cited by 868
Robertson, G. L., Mahr, E. A., Athar, S., & Sinha, T. (1973) · Journal of Clinical Investigation · doi:10.1172/jci107423 · Cited by 787
Urinary Indices of Hydration Status
Armstrong, L. E., Maresh, C. M., Castellani, J. W., Bergeron, M. F., Kenefick, R. W., LaGasse, K. E., & Riebe, D. A. (1994) · International Journal of Sport Nutrition · doi:10.1123/ijsn.4.3.265 · Cited by 768
Self-citationEdelman, I. S., Leibman, J., O'meara, M. P., & Birkenfeld, L. W. (1958) · Journal of Clinical Investigation · doi:10.1172/jci103712 · Cited by 695
American College of Sports Medicine Position Stand: Exercise and Fluid Replacement
Shephard, R. J. (2007) · Yearbook of Sports Medicine · doi:10.1016/s0162-0908(08)70206-x · Cited by 666
Biological Variation: From Principles to Practice
Fraser, C. G. (2001) · Cited by 653
Assessing Hydration Status: The Elusive Gold Standard
Armstrong, L. E. (2007) · Journal of the American College of Nutrition · doi:10.1080/07315724.2007.10719661 · Cited by 643
Physiological measurements of metabolic functions in man.
(1963) · JAMA · doi:10.1001/jama.1963.03700260090052 · Cited by 629
McGee, S. (1999) · JAMA · doi:10.1001/jama.281.11.1022 · Cited by 583
American Medical Association Council on Scientific Affairs
Goodman, C. S. (1988) · Cited by 496
A Manual of Laboratory and Diagnostic Tests
Fischbach, F. T., & Dunning, M. B. (1980) · Cited by 405
GREENLEAF, J. E. (1992) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199206000-00007 · Cited by 376
Respiratory weight losses during exercise.
Mitchell, J. W., NADEL, E. R., & Stolwijk, J. A. (1972) · Journal of Applied Physiology · doi:10.1152/jappl.1972.32.4.474 · Cited by 361
Blood and urinary measures of hydration status during progressive acute dehydration
POPOWSKI, L. A., Oppliger, R. A., Lambert, G. P., Johnson, R. F., Johnson, A. K., & GISOLFI, C. V. (2001) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-200105000-00011 · Cited by 345
Neurogenic disorders of osmoregulation
Robertson, G. L., Aycinena, P., & Zerbe, R. L. (1982) · The American Journal of Medicine · doi:10.1016/0002-9343(82)90825-7 · Cited by 329
Effects of Intra-and Interindividual Variation on the Appropriate Use of Normal Ranges
Harris, E. K. (1974) · Clinical Chemistry · doi:10.1093/clinchem/20.12.1535 · Cited by 325
Gennari, F. J. (1984) · New England Journal of Medicine · doi:10.1056/nejm198401123100207 · Cited by 280
Muscle water and electrolytes following varied levels of dehydration in man
COSTILL, D. L., Cote, R., & Fink, W. (1976) · Journal of Applied Physiology · doi:10.1152/jappl.1976.40.1.6 · Cited by 254
Feig, P. U., & McCurdy, D. K. (1977) · New England Journal of Medicine · doi:10.1056/nejm197712292972608 · Cited by 240
Shift in body fluid compartments after dehydration in humans
Nose, H., Mack, G. W., Shi, X., & NADEL, E. R. (1988) · Journal of Applied Physiology · doi:10.1152/jappl.1988.65.1.318 · Cited by 210
Urine osmolality and conductivity as indices of hydration status in athletes in the heat
Shirreffs, S. M., & Maughan, R. J. (1998) · Medicine & Science in Sports & Exercise · doi:10.1097/00005768-199811000-00007 · Cited by 209
Weinberg, A. D. (1995) · JAMA · doi:10.1001/jama.1995.03530190066035 · Cited by 204
Saliva Parameters as Potential Indices of Hydration Status during Acute Dehydration
Walsh, N. P., Laing, S. J., Oliver, S. J., Montague, J. C., Walters, R. L., & Bilzon, J. (2004) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000139797.26760.06 · Cited by 188
Dorwart, W. V., & Chalmers, L. (1975) · Clinical Chemistry · doi:10.1093/clinchem/21.2.190 · Cited by 184
Language Guiding Therapy: The Case of Dehydration versus Volume Depletion
Mange, K. C., Matsuura, D., Cizman, B., Soto, H., Ziyadeh, F. N., Goldfarb, S., & Neilson, E. G. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-127-9-199711010-00020 · Cited by 176
Daily Body Mass Variability and Stability in Active Men Undergoing Exercise-Heat Stress
Cheuvront, S. N., Carter, R., Montain, S. J., & Sawka, M. N. (2004) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.14.5.532 · Cited by 157
Self-citationCostongs, G. M. P. J., Janson, P., Bas, B. M., Hermans, J., Brombacher, P. J., & van Wersch, J. W. J. (1985) · PubMed · doi:10.18452/12639 · Cited by 157
Weinberg, A. D. (1995) · JAMA · doi:10.1001/jama.274.19.1552 · Cited by 150
The most essential nutrient: Defining the adequate intake of water
Manz, F., Wentz, A., & Sichert‐Hellert, W. (2002) · The Journal of Pediatrics · doi:10.1067/mpd.2002.128031 · Cited by 130
Within- and between-subject variation in commonly measured anthropometric and biochemical variables
Widjaja, A., Morris, R. J., Levy, J. C., Frayn, K. N., Manley, S. E., & Turner, R. C. (1999) · Clinical Chemistry · doi:10.1093/clinchem/45.4.561 · Cited by 129
Stookey, J. D. (2005) · Journal of the American Dietetic Association · doi:10.1016/j.jada.2005.05.003 · Cited by 128
Manz, F. (2007) · Journal of the American College of Nutrition · doi:10.1080/07315724.2007.10719655 · Cited by 117
Change in body mass accurately and reliably predicts change in body water after endurance exercise
Baker, L. B., Lang, J. A., & Kenney, W. L. (2009) · European Journal of Applied Physiology · doi:10.1007/s00421-009-0982-0 · Cited by 110
Biological variability of 26 clinical chemistry analytes in elderly people.
Fraser, C. G., Cummings, S. T., Wilkinson, S. P., Neville, R. G., Knox, J. D. E., Ho, O., & MacWalter, R. S. (1989) · Clinical Chemistry · doi:10.1093/clinchem/35.5.783 · Cited by 108
Setting analytical goals for random analytical error in specific clinical monitoring situations
Fraser, C. G., Peterson, P. H., & Larsen, M. L. (1990) · Clinical Chemistry · doi:10.1093/clinchem/36.9.1625 · Cited by 105
JACOBSON, M. H. (1962) · Archives of Internal Medicine · doi:10.1001/archinte.1962.03620190085013 · Cited by 89
The Biochemistry of Clinical Medicine
Hoffman, W. S. (1960) · The American Journal of the Medical Sciences · doi:10.1097/00000441-196002000-00030 · Cited by 89
The Index of Individuality Is Often a Misinterpreted Quantity Characteristic
Petersen, P. H., Fraser, C. G., Sandberg, S., & Goldschmidt, H. M. J. (1999) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.1999.102 · Cited by 87
Estimating the Area Under a Receiver Operating Characteristic Curve For Repeated Measures Design
Liu, H., & Wu, T. (2003) · Journal of Statistical Software · doi:10.18637/jss.v008.i12 · Cited by 86
Effects of athletes’ muscle mass on urinary markers of hydration status
Hamouti, N., Coso, J. D., Ávila, A., & Mora‐Rodríguez, R. (2010) · European Journal of Applied Physiology · doi:10.1007/s00421-009-1333-x · Cited by 85
Hydration Assessment of Athletes
Cheuvront, S. N., Sawka, M. N., Sawka, M. N., Facsm, P. D., & Ma, N. (2015) · Cited by 81
Self-citationHydration Testing in Collegiate Wrestlers Undergoing Hypertonic Dehydration
Bartok, C., Schoeller, D. A., SULLIVAN, J. C., CLARK, R. R., & Landry, G. L. (2004) · Medicine & Science in Sports & Exercise · doi:10.1249/01.mss.0000117164.25986.f6 · Cited by 76
Temporal Changes in the Concentrations of Serum Constituents in Healthy Men
Harris, E. K., & Brown, S. S. (1979) · Annals of Clinical Biochemistry International Journal of Laboratory Medicine · doi:10.1177/000456327901600142 · Cited by 60
Renal Function: Mechanisms Preserving Fluid and Solute Balance in Health.
(1975) · Annals of Internal Medicine · doi:10.7326/0003-4819-82-1-127_1 · Cited by 57
Costongs, G. M. P. J., Janson, P., Bas, B. M., Hermans, J., van Wersch, J. W. J., & Brombacher, P. J. (1985) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.1985.23.1.7 · Cited by 53
Distinguishing physiologic variation from analytic variation
Harris, E. K. (1970) · Journal of Chronic Diseases · doi:10.1016/0021-9681(70)90055-x · Cited by 49
Short- and long-term biological variation in analytes in urine of apparently healthy individuals.
Shephard, M. D. S., Penberthy, L. A., & Fraser, C. G. (1981) · Clinical Chemistry · doi:10.1093/clinchem/27.4.569 · Cited by 44
Iglesias, N. R., Petersen, P. H., & Ricós, C. (2005) · Clinical Chemistry and Laboratory Medicine (CCLM) · doi:10.1515/cclm.2005.078 · Cited by 42
Hydration level monitoring using embedded piezoresistive microcantilever sensors
Gunter, R. L., Delinger, W. G., Porter, T. L., Stewart, R. F., & Reed, J. (2004) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2004.10.005 · Cited by 35
HOUPT, T. R., & Reece, W. O. (2004) · Cited by 29
Bohnen, N. I., Terwel, D., Ittersum, M. M., Haaf, J. A. T., & Jolles, J. (1992) · Clinical Chemistry · doi:10.1093/clinchem/38.11.2278 · Cited by 27
Human hydration level monitoring using embedded piezoresistive microcantilever sensors
Stewart, R. F., Reed, J., Zhong, J., Morton, K., & Porter, T. L. (2007) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2006.11.003 · Cited by 18
Desirable performance standards for assays of serum water and osmolality.
Jahan, A., Browning, M. C., & Fraser, C. G. (1988) · Clinical Chemistry · doi:10.1093/clinchem/34.5.995 · Cited by 9
Flagged first, then by citations
3 of the 62 references couldn’t be matched to a known paper.
Research works printed but not linked: 2
- Institute of Medicine. Dietary reference intakes for water, potassium, sodium, chloride, and sulfate. Washington, DC: National Academies Press, 2005:73–185.
- Institute of Medicine. Hydration status monitoring. In: Monitoring metabolic status: predicting decrements in physiological and cognitive performance. Washington, DC: National Academies Press, 2004:270–80.
Cited by
Sorted by citations
ESPEN guideline on clinical nutrition and hydration in geriatrics
Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C. C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.05.024 · Cited by 1,505
Périard, J. D., Eijsvogels, T. M. H., & Daanen, H. A. M. (2021) · Physiological Reviews · doi:10.1152/physrev.00038.2020 · Cited by 774
ESPEN practical guideline: Clinical nutrition and hydration in geriatrics
Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C., Sobotka, L., et al. (2022) · Clinical Nutrition · doi:10.1016/j.clnu.2022.01.024 · Cited by 516
Sawka, M. N., Leon, L. R., Montain, S. J., & Sonna, L. A. (2011) · Comprehensive Physiology · doi:10.1002/cphy.c100082 · Cited by 470
Self-citationDehydration: Physiology, Assessment, and Performance Effects
Cheuvront, S. N., & Kenefick, R. W. (2014) · Comprehensive Physiology · doi:10.1002/cphy.c130017 · Cited by 461
Self-citation
Metadata
- Authors
- Cheuvront, S. N., Ely, B. R., Kenefick, R. W., & Sawka, M. N.
- Affiliations
- U.S. Army Research Institute of Environmental Medicine (US)
- Venue
- The American Journal of Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 92
- Issue
- 3
- Pages
- 565-573
- ISSN
- 0002-9165 (ISSN-L)
- OpenAlex
- W1997497052
- Cited by
- 367
- References
- 62
- Citations by year
- 2026: 12 · 2025: 20 · 2024: 26 · 2023: 21 · 2022: 18 · 2021: 29 · 2020: 28 · 2019: 34 · 2018: 26 · 2017: 20 · 2016: 29 · 2015: 28 · 2014: 20 · 2013: 21 · 2012: 23
- FWCI
- 11.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- American Journal of Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Thermoregulation and physiological responses
- Health Sciences › Health Professions › Medical Laboratory Technology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Nephrology › Electrolyte and hormonal disorders
- Keywords
- dehydration assessment, biological variation, plasma osmolality, urine specific gravity, body mass, reference change value, diagnostic accuracy, within-person variability, fluid balance, military medicine, sports medicine
- MeSH terms
- Adult, Body Weight, Dehydration, Female, Humans, Male, Osmolar Concentration, Prospective Studies, Reference Values, ROC Curve, Saliva, Specific Gravity, Biomarkers, Young Adult
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