Hydration & Electrolytes — References

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Parent Topic: Hydration & Electrolytes | References Hub: 01 - Foundations References MOC

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Primary Literature & Landmark Studies

Dmitrieva et al. (2023)

• Citation: Dmitrieva, N. I., Gagarin, A., Liu, D., Wu, C. O., & Boehm, M. (2023). Middle-age high normal serum sodium as a risk factor for accelerated biological aging, chronic diseases, and premature mortality. eBioMedicine, 87, 104404.
• Identifiers: DOI: 10.1016/j.ebiom.2022.104404 (DOI · SciDB · Scholar) | PMID: 36599719 (PubMed · Europe PMC)
• Study Design: 25-year prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study ($N=11,255$ adults aged 45–66 at baseline).
• Key Quantitative Outcomes:
  • Compared to the optimal reference range of $137–142\text{mmol/L}$, middle-aged adults with high-normal serum sodium ($>142\text{mmol/L}$, reflecting chronic subclinical hypohydration and elevated vasopressin) exhibited a 39% increased hazard of developing chronic diseases (heart failure, stroke, atrial fibrillation, diabetes, dementia; $\text{HR}=1.39,p<0.001$), 50% higher odds of biological age exceeding chronological age ($\text{OR}=1.50$), and a 21% increased risk of premature mortality ($\text{HR}=1.21,p=0.006$ at $>144\text{mmol/L}$).

O’Donnell et al. (2014)

• Citation: O’Donnell, M., Mente, A., Rangarajan, S., McQueen, M. J., Wang, X., Liu, L., Yan, H., Lee, S. F., Mony, P., Devanath, A., Rosengren, A., Lopez-Jaramillo, P., Diaz, R., Avezum, A., Lanas, F., Yusoff, K., Iqbal, R., Ilow, R., Mohammadifard, N., … & Yusuf, S. (2014). Urinary sodium and potassium excretion, mortality, and cardiovascular events. New England Journal of Medicine, 371(7), 612–623.
• Identifiers: DOI: 10.1056/NEJMoa1311889 (DOI · SciDB · Scholar) | PMID: 25119607 (PubMed · Europe PMC)
• Study Design: Prospective international cohort study (Prospective Urban Rural Epidemiology [PURE], $N=101,945$ adults across 17 countries followed for a mean of 3.7 years).
• Key Quantitative Outcomes:
  • Identified a J-shaped relationship between urinary sodium excretion and death/major cardiovascular events: the lowest risk occurred at 3.0 to 6.0 g/day of sodium.
  • Sodium excretion $<3.0\text{g/day}$ was associated with a 27% higher risk of death and major cardiovascular events ($\text{OR}=1.27,95\%\text{CI}[1.12,1.44]$) due to renin-angiotensin-aldosterone activation, whereas higher potassium excretion ($\ge 3.0\text{g/day}$) was associated with a 22% lower risk of death and cardiovascular events ($\text{OR}=0.78,p<0.001$).

Maughan et al. (2016)

• Citation: Maughan, R. J., Watson, P., Cordery, P. A., Walsh, N. P., Oliver, S. J., Dolci, A., Rodriguez-Sanchez, N., & Galloway, S. D. (2016). A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index. The American Journal of Clinical Nutrition, 103(3), 717–723.
• Identifiers: DOI: 10.3945/ajcn.115.114769 (DOI · SciDB · Scholar) | PMID: 26702122 (PubMed · Europe PMC)
• Study Design: Randomized, controlled crossover clinical trial in euthydrated healthy males ($N=72$) comparing cumulative 4-hour urine output and net fluid balance after ingesting 1.0 L of 13 different beverages relative to still water.
• Key Quantitative Outcomes:
  • Oral rehydration solution (containing $1,350\text{mg/L}{\text{Na}}^{+}$ and $780\text{mg/L}{\text{K}}^{+}$) achieved a Beverage Hydration Index (BHI) of 1.54 ($p<0.001$ vs. still water $\text{BHI}=1.00$), retaining >50% more ingested fluid inside the body over 4 hours by preventing hypotonic osmoreceptor-triggered diuresis.

Wittbrodt & Millard-Stafford (2018)

• Citation: Wittbrodt, M. T., & Millard-Stafford, M. (2018). Dehydration impairs cognitive performance: A meta-analysis. Medicine & Science in Sports & Exercise, 50(11), 2360–2368.
• Identifiers: DOI: 10.1249/MSS.0000000000001682 (DOI · SciDB · Scholar) | PMID: 29933347 (PubMed · Europe PMC)
• Study Design: Systematic review and meta-analysis of 33 experimental studies ($N=413$ subjects, 289 effect sizes).
• Key Quantitative Outcomes:
  • Hypohydration significantly impaired overall cognitive performance ($d=-0.21,p<0.001$), with substantial deficits emerging once body water loss exceeded 2% of body mass ($d=-0.28,p=0.002$), disproportionately degrading high-order attention ($d=-0.52$), motor coordination ($d=-0.40$), and executive function ($d=-0.24$).