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International Journal of Clinical... Sep 2020The impact of food and drinks on body fluid metabolism is of direct clinical relevance but current evidence remains fragmented.
CONTEXT
The impact of food and drinks on body fluid metabolism is of direct clinical relevance but current evidence remains fragmented.
AIM
Synthesise current evidence on the role of food and drinks in urine production.
METHODS
Systematic review as per PRISMA guidelines using MEDLINE and EMBASE databases (completed October 2019). Studies reporting on the effect of food, food constituents, and drinks on urine production were included. Two authors performed an independent extraction of relevant articles using predetermined data sets and completed quality-of-study indicators.
RESULTS
A total of 49 studies were included, of which 21 enroled human subjects, and 28 were clinically relevant animal studies (all of which utilised rodent models). The included studies were determined to be of variable quality. High dietary sodium, as well as wine, spirits, high-caffeine coffee, and caffeinated energy drinks, increased urine production in human studies. Decreased urine production was associated with low dietary sodium and consumption of milk, orange juice, and high-salt/high-sugar drinks. In animal models, a variety of fruits, vegetables, herbs, spices, and honey were associated with increased urine production.
CONCLUSION
Current evidence suggests that although several types of food and drinks may impact body fluid metabolism, the quality of the data is variable. Urine production appears to be influenced by multiple factors including composition (ie, moisture, macronutrients, and electrolytes), metabolite load, and the presence of specific diuresis-promoting substances (eg, caffeine, alcohol) and other bioactive phytochemicals. Future research is needed to support current evidence and the physiologic mechanisms underlying these findings.
Topics: Animals; Beverages; Coffee; Diuresis; Drinking; Food; Humans; Osmolar Concentration; Urination
PubMed: 32441853
DOI: 10.1111/ijcp.13539 -
Journal of the American College of... Feb 2021Frequent monitoring of hydration status may help to avoid the adverse effects of dehydration. Other than urine color assessment, hydration assessment methods are largely...
Frequent monitoring of hydration status may help to avoid the adverse effects of dehydration. Other than urine color assessment, hydration assessment methods are largely impractical for the general population and athletes to implement on a routine basis. Despite its widespread use, the validity of urine color as an indicator of hydration status has not been systematically evaluated. The objective of this systematic review is to determine the validity of urine color evaluation as a hydration status assessment method in the general adult population, older adults, and athletes. Using the PRISMA guidelines, electronic databases were searched to identify original research articles of all study design types for inclusion. Of the 424 articles screened, 10 met inclusion criteria. Most studies compared urine color to either urinary specific gravity or urine osmolality, and reported significant associations (r) ranging from 0.40 to 0.93. Lower correlations were noted in studies of adults aged >60 years. Studies generally reported a high sensitivity of urine color as a diagnostic tool for detecting dehydration and supported the ability of this method to distinguish across categories of hydration status. Research is needed to determine if clinicians, patients, and clients can accurately utilize this method in clinical and real-world settings. Future research is also needed to extend these findings to other populations, such as children.Key teaching pointsInadequate hydration can lead to impairments in physical performance and cognitive function.Methods used to assess hydration status include plasma/serum osmolality, urinary specific gravity (USG), urine osmolality (Uosm), change in body weight, urine volume, and urine color.Urine color assessment is a practical method that is routinely used in clinical, athletic, and other settings. The validity of this method has not been systemically evaluated.Available research was limited to 10 articles.Validity of this method was generally supported; however, research has not investigated the validity of this method by clinicians, patients and clients.
Topics: Aged; Athletes; Biomarkers; Child; Dehydration; Humans; Osmolar Concentration; Urinalysis; Urine
PubMed: 32330109
DOI: 10.1080/07315724.2020.1750073 -
Clinical Imaging May 2020Comparison of iso-osmolar contrast media (IOCM) and low-osmolar contrast media (LOCM) for vascular attenuation, image quality, heart rate changes, and common patient... (Meta-Analysis)
Meta-Analysis
Comparative effect of iso-osmolar versus low-osmolar contrast media on vascular attenuation, image quality, and heart rate changes in coronary CT angiography: A systematic review and meta-analysis.
OBJECTIVES
Comparison of iso-osmolar contrast media (IOCM) and low-osmolar contrast media (LOCM) for vascular attenuation, image quality, heart rate changes, and common patient discomfort symptoms.
METHODS
We searched PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL). We included only randomized controlled trials. Screening, data extraction, and quality assessment were done by three independent authors. RevMan 5.3 software was used for meta-analysis.
RESULTS
Nine studies (n = 1831 participants) were found eligible and included in the meta-analysis. There was no difference between the both contrast media for vascular attenuation (mean difference = -21.31; 95% confidence interval -49.81 to 7.19; p = 0.14), image quality (standardized mean difference = 0.13; 95% confidence interval -0.07 to 0.33; p = 0.19), heart rate variability (standardized mean difference = -0.61; 95% confidence interval -1.30 to 0.09; p = 0.09), heat sensation (risk ratio = 0.79; 95% confidence interval 0.56 to 1.11; p = 0.17), and nausea or vomiting (risk ratio = 0.82; 95% confidence interval 0.52 to 1.28; p = 0.38). Moreover, IOCM resulted in a heart rate that was lower by 0.9 beat per minute (bpm) compared to LOCM (mean difference = -0.92; 95% confidence interval -1.81 to -0.03; p = 0.04).
CONCLUSIONS
Both IOCM and LOCM have similar vascular enhancement, image quality, heart rate variability, and similar risk for patient discomfort. Furthermore, IOCM resulted in a slightly lower heart rate by 0.9 bpm.
Topics: Computed Tomography Angiography; Contrast Media; Coronary Angiography; Heart Rate; Humans; Middle Aged; Odds Ratio; Osmolar Concentration; Triiodobenzoic Acids
PubMed: 31982704
DOI: 10.1016/j.clinimag.2020.01.016 -
Biomarkers : Biochemical Indicators of... Feb 2020Acute intoxications account for a significant proportion of the patient population in intensive care units and sedative medications, ethanol, illicit drugs, inhalable...
Acute intoxications account for a significant proportion of the patient population in intensive care units and sedative medications, ethanol, illicit drugs, inhalable poisons and mixed intoxications are the most common causes. The aim of this article is to describe biomarkers for screening and diagnosis of acute intoxications in critically ill patients. For this purpose, a survey of the relevant literature was conducted, and guidelines, case reports, expert assessments, and scientific publications were reviewed. In critical care, it should always be attempted to identify and quantify the poison or toxin with the assistance of enzyme immunoassay (EIA), chromatography, and mass spectrometry techniques and this section is critically appraised in this publication. The principles for anion gap, osmol gap and lactate gap and their usage in intoxications is shown. Basic rules in test methodology and pre-analytics are reviewed. Biomarkers in general are presented in part one and biomarkers for specific intoxications including ethanol, paracetamol, cardiovascular drugs and many others are presented in part two of these publications.
Topics: Acute Disease; Biomarkers; Critical Illness; Drug Overdose; Drug-Related Side Effects and Adverse Reactions; Humans; Poisoning; Predictive Value of Tests; Prognosis
PubMed: 31735069
DOI: 10.1080/1354750X.2019.1694994 -
European Journal of Sport Science Jul 2020Pre-exercise hypohydration can impair soccer performance and has been extensively studied in different soccer populations. Therefore, the aim of this systematic review...
Pre-exercise hypohydration can impair soccer performance and has been extensively studied in different soccer populations. Therefore, the aim of this systematic review was to report hypohydration prevalence, measured by blood or urine samples, in different soccer populations based on sex (males and females), performance level (professional and recreational players) and context (training sessions and games). The Pubmed, Web of Science and SPORTDiscus databases were systematically searched until November 2018. Data were pooled to compare hypohydration prevalence between the different subgroups. Following the systematic search selection process, 24 studies were included. The results indicated that overall pre-exercise hypohydration prevalence was 63.3%, 37.4% and 58.8% for urine specific gravity (USG), urine osmolality (U Osm) and urine colour, respectively. Furthermore, no study implemented blood samples to examine hypohydration prevalence in soccer players. The subgroup analyses using USG data indicated that pre-exercise hypohydration prevalence was significantly higher amongst males (66.0%; = 0.001), professional soccer players (66.2%; = 0.020) and before a training session (79.6%; < 0.001). Pre-exercise hypohydration prevalence was 46.8% among female soccer players, 55.6% in recreational soccer players and 41,3% before a game. The subgroup analyses using U Osm data indicated that hypohydration prevalence was significantly higher before a training session (52.6%; = 0.023). Based on these results, it can be concluded that hypohydration prevalence in soccer players is of major concern. Future research should explore how pre-exercise hydration status can be improved in a sustainable way.
Topics: Athletic Performance; Bias; Cohort Studies; Cross-Sectional Studies; Dehydration; Female; Humans; Male; Osmolar Concentration; Prevalence; Sex Factors; Soccer; Specific Gravity; Urinalysis; Urine
PubMed: 31526234
DOI: 10.1080/17461391.2019.1669716 -
European Archives of... Dec 2019To develop clinical tools assessing the refluxogenic potential of foods and beverages (F&B) consumed by patients with laryngopharyngeal reflux (LPR).
OBJECTIVE
To develop clinical tools assessing the refluxogenic potential of foods and beverages (F&B) consumed by patients with laryngopharyngeal reflux (LPR).
METHODS
European experts of the LPR Study group of the Young-Otolaryngologists of the International Federation of Oto-rhino-laryngological societies were invited to identify the components of Western European F&B that would be associated with the development of LPR. Based on the list generated by experts, four authors conducted a systematic review to identify the F&B involved in the development of esophageal sphincter and motility dysfunctions, both mechanisms involved in the development of gastroesophageal reflux disease and LPR. Regarding the F&B components and the characteristics identified as important in the development of reflux, experts developed three rational scores for the assessment of the refluxogenic potential of F&B, a dish, or the overall diet of the patient.
RESULTS
Twenty-six European experts participated to the study and identified the following components of F&B as important in the development of LPR: pH; lipid, carbohydrate, protein composition; fiber composition of vegetables; alcohol degree; caffeine/theine composition; and high osmolality of beverage. A total of 72 relevant studies have contributed to identifying the Western European F&B that are highly susceptible to be involved in the development of reflux. The F&B characteristics were considered for developing a Refluxogenic Diet Score (REDS), allowing a categorization of F&B into five categories ranging from 1 (low refluxogenic F&B) to 5 (high refluxogenic F&B). From REDS, experts developed the Refluxogenic Score of a Dish (RESDI) and the Global Refluxogenic Diet Score (GRES), which allow the assessment of the refluxogenic potential of dish and the overall diet of the LPR patient, respectively.
CONCLUSION
REDS, RESDI and GRES are proposed as objective scores for assessing the refluxogenic potential of F&B composing a dish or the overall diet of LPR patients. Future studies are needed to study the correlation between these scores and the development of LPR according to impedance-pH study.
Topics: Adult; Beverages; Diet; Electric Impedance; Esophagitis, Peptic; Female; Food; Humans; Hydrogen-Ion Concentration; Laryngopharyngeal Reflux; Male; Middle Aged; Otolaryngologists; Otolaryngology; Severity of Illness Index
PubMed: 31515662
DOI: 10.1007/s00405-019-05631-1 -
Current Environmental Health Reports Sep 2019Urinary biomonitoring is widely used to assess environmental chemical exposure; however, a critical gap exists in whether and how to correct for the physiological...
BACKGROUND
Urinary biomonitoring is widely used to assess environmental chemical exposure; however, a critical gap exists in whether and how to correct for the physiological variation in water content of spot urine samples.
OBJECTIVE
The aim of this systematic review is to summarize the available evidence comparing the performance of urinary concentration correction methods used to determine urinary levels of arsenic, cadmium, and mercury.
METHODS
We searched PubMed/MEDLINE, Embase, LILIAC, Web of Science, and TOXNET up to Sept. 5, 2017 for articles evaluating urinary concentration correction methods (e.g., urine creatinine [U-Cre], specific gravity [U-SG], osmolality [U-Osm]) compared to 24-h or timed urine specimens for levels of arsenic, cadmium, and mercury. Data on study design, methods of urine collection, and the performance of selected correction methods were extracted.
RESULTS
A total of 10 papers met the inclusion criteria. Two papers evaluated the performance of urinary concentration correction methods for arsenic, four for cadmium, three for mercury, and one for multiple metals. The median sample size for arsenic was 105, for cadmium 107, and for mercury 35. The studies were highly heterogeneous in population selection, urine collection, urine quality control, statistical comparison among selected correction methods, and presentation of the results. The median (range) of correlation coefficients comparing each corrected values with corresponding levels of timed urine specimens are 0.74 (0.17-0.92) for un-correction (n = 13), 0.82 (0.52-0.98) for U-Cre (n = 13), and 0.75 (0.28-0.98) (n = 12) for U-SG.
CONCLUSION
Findings from limited evidence support that urine creatinine and urine-specific gravity corrections remain practical approaches to correct metal concentrations for urine dilution as compared to 24-h or 12-h urine samples. Further studies with larger sample sizes are needed to clarify this fundamental issue of environmental biomonitoring using spot urine samples in both general and priority populations.
Topics: Arsenic; Biomarkers; Cadmium; Environmental Exposure; Environmental Pollutants; Female; Humans; Mercury; Specific Gravity; Urinalysis
PubMed: 31372861
DOI: 10.1007/s40572-019-00242-8 -
Cancer Imaging : the Official... Jun 2019Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium. Whether there is a... (Comparative Study)
Comparative Study Meta-Analysis
Comparative effect of iso-osmolar versus low-osmolar contrast media on the incidence of contrast-induced acute kidney injury in diabetic patients: a systematic review and meta-analysis.
BACKGROUND
Contrast-induced acute kidney injury (CI-AKI) is a major adverse effect caused by intravascular administration of iodinated contrast medium. Whether there is a difference in CI-AKI incidence between iso-osmolar (IOCM) and low-osmolar contrast media (LOCM) among diabetic patients is controversial.
METHODS
Randomized controlled trials comparing the nephrotoxic effects between IOCM and LOCM in diabetic patients with or without CKD (eGFR< 60 ml/min/1.73 m) were included in the analysis. The incidence of CI-AKI was defined as an initial increase in serum creatinine (SCr) concentration of at least 0.5 mg/dl or a rise in creatinine of 25% from baseline.
RESULTS
A total of 2190 patients were included, among whom 1122 patients received IOCM and 1068 received LOCM. When compared to LOCM, IOCM had no significant benefit in preventing CI-AKI (OR = 1.66, [CI: 0.97-2.84], P = 0.06, I = 54%). However, the difference between IOCM and LOCM was found when CI-AKI was defined as an absolute SCr increase (≥0.5 mg/dl) rather than a relative SCr increase (≥25%). Further analysis showed that LOCM resulted in more adverse events.
CONCLUSIONS
Whether there is a difference of CI-AKI incidence between IOCM and LOCM in diabetic patients was related to the selected diagnostic criteria. The incidence of adverse events was significantly lower with IOCM when compared with LOCM. Therefore, we suggest that IOCM may be used in diabetic and CKD (eGFR< 60 ml/min/1.73 m) patients.
Topics: Acute Kidney Injury; Contrast Media; Diabetes Mellitus; Female; Humans; Male; Osmolar Concentration; Randomized Controlled Trials as Topic
PubMed: 31215488
DOI: 10.1186/s40644-019-0224-6 -
European Journal of Nutrition Mar 2019Athletes in Olympic combat sports experience body water fluctuations resulting from training and intentional dehydration when making weight. Despite the popularity of... (Meta-Analysis)
Meta-Analysis
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) and urine osmolality (U) 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 and U the main outcome variables. Meta-regression analyses evaluated the interrelationship among body mass (B), fluid intake, and urine measures.
RESULTS
Significant U 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 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 alterations (p = 0.044) during rehydration protocols.
CONCLUSIONS
There were likely small changes in both U and U readings across all experimental conditions, with moderate-to-large heterogeneity in all studies, except for U readings during dehydration protocols. The meta-regression failed to provide conclusive evidence concerning the interrelationship among urine measures, B fluctuations, and fluid intake.
Topics: Adult; Athletes; Dehydration; Drinking; Female; Humans; Male; Osmolar Concentration; Sports; Urinalysis; Water-Electrolyte Balance; Young Adult
PubMed: 30820653
DOI: 10.1007/s00394-019-01937-2 -
Acta Bio-medica : Atenei Parmensis Dec 2018Contrast enhanced Computed Tomography (CCT) is the most used imaging test to investigate acute abdominal clinical conditions, because of its high sensitivity and...
Is the risk of contrast-induced nephropathy a real contraindication to perform intravenous contrast enhanced Computed Tomography for non-traumatic acute abdomen in Emergency Surgery Department?
BACKGROUND
Contrast enhanced Computed Tomography (CCT) is the most used imaging test to investigate acute abdominal clinical conditions, because of its high sensitivity and specificity. It is mandatory to make a correct and prompt diagnosis when life threatening abdominal diseases as mesenteric ischemia are suspected. Contrast medium administration was linked to acute renal failure, therefore radiologist often prefer to perform CCT without contrast in patients needing to undergo the exam with increased serum creatinine. The aim of the review was to focus on the incidence of contrast induced nephropathy in patients presenting non-traumatic acute abdominal clinical conditions, who underwent CCT with intravenous contrast agent administration in emergency setting.
MATERIALS AND METHODS
The systematic review protocol was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocol (PRISMA-P). Quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.
RESULTS
The strongest currently available evidence on the incidence of post-contrast acute kidney injury (AKI) following intravenous contrast agent administration consists in a meta-analysis of observational studies. Data extracted from meta-analyses demonstrate that, compared with non-contrast CT, CCT was not significantly associated with AKI. Moreover, the risk of AKI (RR=0.79; 95% confidence interval [CI]: 0.62, 1.02; P=.07), death (RR=0.95; 95% CI: 0.55, 1.67; P=.87), and dialysis (RR=0.88; 95% CI: 0.23, 3.43; P=.85) is similar, compared with the risk of AKI in the non-contrast medium group. Furthermore, intravenous low-osmolality iodinated contrast material is a nephrotoxic risk factor, but not in patients with a stable SCr level less than 1.5 mg/dL, therefore many factors other than contrast material could affect PC-AKI rates.
DISCUSSION AND CONCLUSIONS
The benefits of diagnostic information gained from contrast enhanced TC in assessing AA are fundamental in some clinical scenarios. The risk of contrast induced nephropathy (CIN) is negligible in patients with normal renal function but the incidence appears to rise to as high as 25% in patients with pre-existing renal impairment or in the presence of risk factors such as diabetes, advanced age, vascular disease and use of certain concurrent medications. The incidence of CIN/AKI after intravenous contrast administration is very low in general population. Radiologists and referring physicians should be familiar with the risk factors for renal disease, CIN and preventing measures.
Topics: Abdomen, Acute; Acute Kidney Injury; Clinical Trials as Topic; Contraindications, Drug; Contrast Media; Emergencies; Emergency Service, Hospital; Humans; Incidence; Injections, Intravenous; Meta-Analysis as Topic; Retrospective Studies; Risk Assessment; Risk Factors; Selection Bias; Tomography, X-Ray Computed
PubMed: 30561410
DOI: 10.23750/abm.v89i9-S.7891