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Validating Hydration Assessment Tools for an Athletic Population: An Effort To Prevent Dehydration

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For many of us, hearing the term “dehydration” brings a sweat-covered athlete to mind. Perhaps a marathon runner or a basketball star at the end of a close game. The individual has pushed themselves to the absolute limit, ridding their body of so much water in order to cool off that it is difficult to replenish their fluids fast enough and stay properly hydrated. 

Dehydration is a
well-documented hindrance to athletic performance. Staying properly hydrated for race day or the big game is obviously of utmost importance, but maintaining proper hydration for daily practices and training sessions is also crucial

Dr Samantha Kostelnik, a recent graduate of the Department of Human Nutrition, Foods, and Exercise (HNFE) doctoral program at Virginia Tech and a fellow with the Water INTERface Interdisciplinary Graduate Education Program (IGEP), has undertaken research that seeks to enhance athlete hydration.

A novel study

Kostelnik’s most recent study assesses two tools that are used to understand hydration—the
BEVQ-15 and a urine color assessment. The BEVQ-15 is a beverage questionnaire that asks respondents to mark how often and how much they drink 15 different types of beverages. Respondents are asked to recall their beverage intake over the past month so that the questionnaire is representative of habitual beverage intake. The urine color assessment is conducted by comparing urine color to an eight-scale chart that connects urine color with hydration level. Lighter shades of yellow indicate greater amounts of water in the urine and a more hydrated individual. The BEVQ-15 allows for assessment of human beverage intake, and the urine color assessment is a marker of current hydration status. In combination, these tools can be used to understand the hydration status of an individual and inform proper beverage intake. 

An example urine color chart. Credit: Samantha Kostelnik.

In order to have confidence in using these tools to assess hydration, they must first be validated. “Dr Valisa Hedrick in HNFE developed and validated the BEVQ-15, but to date we have only studied the validity of this tool in the general population of adults and children,” says Dr Brenda Davy, professor in HNFE and fellow with the Water INTERface IGEP. Similarly, the urine color charts had never been validated for a wide-ranging population of athletes. Kostelnik undertook this project in the hopes that, upon validation for an athletic population, the tools will be used by sports practitioners to aid athlete hydration.

Athletes from two D1 Virginia universities and a range of different sports, including football, basketball, volleyball, soccer, baseball, softball, tennis, golf, dance, cross country, track and field and swimming, were recruited to participate in the study, which was broken into three distinct sessions. The athletes were asked to complete a BEVQ-15 questionnaire and perform a self-assessment of urine color at the first and third sessions. At each of the three sessions, athletes gave a 24-hour dietary recall — a listing of all the foods and beverages consumed by an individual in the last 24 hours. 

Administering the 24-hour dietary recall three separate times allowed for a depiction of habitual beverage intake that could be used to validate the BEVQ-15. To validate the athlete’s urine color assessments, a refractometer was used to determine urinary specific gravity, which measures dissolved chemicals in urine and is
directly related to urine color. By comparing urinary specific gravity measurements with athlete-determined values on the urine color chart, the performance of the athlete’s identification of their hydration status could be determined. 

Results and next steps

The athlete’s BEVQ-15 and urine color assessment both matched well with their respective validation tests. This showed that performing urine color assessments and filling out the BEVQ-15 questionnaire are reliable hydration assessment tools for athletic populations. Sports practitioners could use the tools to evaluate athlete’s hydration and develop dietary plans that help athletes to stay hydrated and ultimately improve their health and performance. 

Despite the successful validation, Kostelnik noted that there are some areas for improvement for both the BEVQ-15 and urine color assessment. “The BEVQ-15 did not include all the different types of drinks that athletes were consuming such as protein shakes, chocolate milk, and more,” she said. “Including these other drinks could make the questionnaire even more accurate and useful for those assessing an athlete’s beverage intake.”

While athletes performed well in assessing their urine color there are some caveats. Urine color can be affected by
food, medication, and supplement intake. This means that hydration status indicated by urine color could be misleading for certain individuals. Additionally, some athletes struggled to differentiate between well hydrated and mildly dehydrated on the urine color chart, an issue which Kostelnik believes could be mitigated by providing athletes with a short training session on how to use the urine color chart. 

Individuals performing urine color assessments could also benefit from increased ubiquity of the urine color chart. The more familiar an individual is with urine color charts, the more likely they are to be able to differentiate between the different hydration levels. Kostelnik would like to see urine color charts become commonplace in relevant locations such as bathrooms. If an individual sees a urine color chart each time before doing their business, they are much more likely to take note of their hydration status. 

Being aware of hydration status is a crucial step in preventing dehydration, according to Kostelnik. “A lot of athletes are dehydrated, and it’s generally because of a lack of awareness about hydration,” she said. In fact, 70% of the athletes who participated in the study were dehydrated at the time of providing urine samples. 70% is an extremely high number, but Kostelnik’s research could help to bring it down. Now that the BEVQ-15 and urine color assessment have been validated for a wide-ranging athletic population, they can be used by sports practitioners to facilitate adequate athlete hydration. Davy summarized the possible uses of these tools in athletes: “Samantha’s research suggests that trainers, sports dietitians, and others working with collegiate athletes could use the BEVQ-15 and urine color assessments to evaluate athletes’ beverage intake habits and hydration quickly and recommend changes, if needed”.

Athletes aren’t likely to stop pushing themselves or stop sweating, but they could be much less likely to feel the negative effects of dehydration thanks to Dr Kostelnik and the Virginia Tech Water INTERface IGEP, which supported her work. Dr Andrea Dietrich, a Water INTERface co-director, praised the work for expanding the interdisciplinary nature of the Water INTERface IGEP program. “Water is a universal substance. The Water INTERface IGEP invests in research that promotes understanding of water’s interdisciplinary role for healthy humans and a healthy planet. The work of Drs Kostelnik and Davy gives all of us more reasons to consume beverages and stay hydrated,” she said.  

Recommendations for all

Kostelnik’s recent study pertains specifically to athletes, but its findings also have important implications for the rest of us. Dehydration has a range of
negative side effects even for those who don’t spend multiple hours a day in the gym. To decrease the amount of people walking around in a state of constant dehydration, Kostelnik wants to increase public awareness of the signs of dehydration and spread knowledge on how to hydrate properly. Below are some of the common signs of dehydration and some tips for how to stay properly hydrated throughout the day.  

Dehydration is the act of losing water in the body. A 1 - 2% loss in body water is considered mild dehydration, which can lead to the following common side effects:

  • Headaches 
  • Increased anxiety 
  • Increased heart rate 
  • Decreased concentration and memory loss 

Hypohydration, or when the body fails to restore lost fluids, has even more severe side effects. A 2 - 4% loss in body water is considered severe hypohydration and is associated with the following indicators: 

  • Fatigue 
  • Muscle cramps 
  • Cardiovascular strain 
  • Decrease in cognitive function

Obviously, it is in everyone’s best interest to avoid dehydration and its many side effects, but many of us still go through our days without properly hydrating. Kostelnik recommends the following strategies to maintain adequate hydration throughout the day: 

  • Consume fluids through the day in a bottle or cup, particularly water, but also fluids with electrolytes like sports drinks, milk, or orange juice.
  • Some foods also contain substantial amounts of water and can be hydrating when eaten. Fresh fruits and vegetables are the go-to here; celery, cucumber, watermelon, tomatoes, and strawberries have some of the highest percentage of water in the food world. 
  • Finally, checking your urine color is a quick and simple way to assess your current hydration level and can be used to ensure you stay at a properly hydrated level. The following links will direct you to freely available versions of the urine color chart and BEVQ-15 used in this study.