Chronic low water intake may raise the risk of morbidity and mortality by influencing key water regulating hormones (e.g., AVP), which are known to modulate glucoregulation and renal function. For example, AVP stimulates the HPA axis to release the glucocorticoid stress hormone cortisol with potentially far-reaching effects on metabolism, immunity and inflammation. One study observed elevated blood cortisol in a group of low water drinkers, albeit cortisol was measured at one time of day only. However, in the field of psychobiology, researchers have traditionally related more dynamic assessments of cortisol with health outcomes; by evoking cortisol responses to acute standardised laboratory stressors, such as The Trier social stress test. More recently, researchers have appreciated the importance of circadian variability in cortisol levels, by examining influences on, and consequences of individual differences in the diurnal variation of cortisol. The major measurable parameters of the diurnal variation are; the cortisol awakening response (CAR), which is the rise in cortisol during the first 30-45 minutes following awakening, and the diurnal cortisol slope, which is the rate of decline in cortisol levels across the day, from morning to evening. These parameters are considered to reflect different aspects of HPA axis function; with the CAR best reflecting the adrenal capacity to respond to stress and awakening and diurnal slope more indicative of daily cortisol exposure. Although distinct, both blunted CAR and a flattened diurnal cortisol slope appear to be consistent markers of HPA axis dysfunction and related to a variety of poor health outcomes. Therefore, it has been recommended that contemporary research should simultaneously estimate an individual's awakening cortisol responsiveness, and diurnal slope, thereby capturing distinct and important components of HPA axis function. The shared pathways that regulate body water, diurnal variation in cortisol and our response to stress underpin the broad aim of this research programme: to investigate the influence of low and high fluid intake on diurnal cortisol variation and the cortisol response to acute stress. The aims of this study are to investigate: 1. The influence of a change in water intake behaviour on diurnal saliva cortisol variation as assessed by the CAR (primary outcome) 2. The influence of a change in water intake behaviour on biomarkers of hydration and thirst as assessed by urine osmolality, urine colour and thirst sensation. 3. The influence of habitual low and high total fluid intake on saliva cortisol response to an acute psychological stress (secondary outcome) 4. Investigate the influence of a change in water intake behaviour on plasma biomarkers of hydration as assessed by plasma osmolality and plasma copeptin (exploratory outcome)
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
NONE
Enrollment
71
1-week intervention where the intake of drinking water will either be increased (if habitually low) or decreased (if habitually high). The total fluid intake (TFI) prescriptions during the intervention are derived from the mean TFI of habitually high and habitually low drinkers from a sex, age and country matched population. Specifically, habitually high drinkers will be permitted a TFI of 1.3 L/day and habitually low drinkers will be permitted a TFI of 3.5 L/day for men and 3.3 L/day for women. Participants will be instructed to maintain their usual intake of other beverages i.e., tea/coffee to achieve their target TFI. The diurnal saliva cortisol response at rest will be examined at the end of both experimental periods and the saliva cortisol response to an acute psychological stress will be examined at the end of the habitual experimental period only.
Liverpool John Moores University
Liverpool, Merseyside, United Kingdom
Cortisol awakening response (CAR)
A biomarker for Hypothalamic Pituitary Adrenal activity; a naturally occurring increase in cortisol upon waking, assessed by ELISA
Time frame: Assessed during the first 45 minutes after awakening
Urine Osmolality
The concentration of osmotic solutes present in the urine, measured using a freezing point depression osmometer;
Time frame: Mid-afternoon urine samples will be collected on days 2, 5, 6 and 7 during the habitual and on days 10, 13 and 14 of the intervention periods. T
Change in saliva cortisol to acute psychological stress
Changes in the concentration of saliva free cortisol assessed by ELISA
Time frame: Delta changes (increase/ decrease) in cortisol response (calculated by subtracting the baseline cortisol value from the peak post-stress induction level (-30 minutes pre-stress minus 10 minutes post-stress)
Urine colour
urine colour which is a common urinary marker used for assessing hydration status, assessed using a urine colour chart has been developed to assess urine concentration in healthy humans;
Time frame: Mid-afternoon urine samples will be collected on days 2, 5, 6 and 7 during the habitual and on days 10, 13 and 14 of the intervention periods. T
Thirst sensation
subjective rating of thirst will be obtained from a 0-9 thirst sensation scale (0 = "not thirsty at all" to 9 = "very, very thirsty")
Time frame: hirst sensation will be collected for daily for a total of 15 days across the habitual and intervention periods.
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