Comprehensive Physiology Wiley Online Library

Optimal Composition of Fluid‐Replacement Beverages

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Abstract

The objective of this article is to provide a review of the fundamental aspects of body fluid balance and the physiological consequences of water imbalances, as well as discuss considerations for the optimal composition of a fluid replacement beverage across a broad range of applications. Early pioneering research involving fluid replacement in persons suffering from diarrheal disease and in military, occupational, and athlete populations incurring exercise‐ and/or heat‐induced sweat losses has provided much of the insight regarding basic principles on beverage palatability, voluntary fluid intake, fluid absorption, and fluid retention. We review this work and also discuss more recent advances in the understanding of fluid replacement as it applies to various populations (military, athletes, occupational, men, women, children, and older adults) and situations (pathophysiological factors, spaceflight, bed rest, long plane flights, heat stress, altitude/cold exposure, and recreational exercise). We discuss how beverage carbohydrate and electrolytes impact fluid replacement. We also discuss nutrients and compounds that are often included in fluid‐replacement beverages to augment physiological functions unrelated to hydration, such as the provision of energy. The optimal composition of a fluid‐replacement beverage depends upon the source of the fluid loss, whether from sweat, urine, respiration, or diarrhea/vomiting. It is also apparent that the optimal fluid‐replacement beverage is one that is customized according to specific physiological needs, environmental conditions, desired benefits, and individual characteristics and taste preferences. © 2014 American Physiological Society. Compr Physiol 4:**‐**, 2014.

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Figure 1. Figure 1. Effect of no water vs. ad libitum water intake vs. water intake to match sweat losses on rectal temperature during marching in the heat (37.8°C, 35%‐45% relative humidity) in 1 male subject. Reprinted (with permission) from Pitts et al. ().
Figure 2. Figure 2. Body fluid compartments that comprise 42 L of total body water in a 70 kg human, and sources of fluid gain or loss. Reprinted (with permission) from Armstrong ().
Figure 3. Figure 3. Predictions of daily water requirements as a function of daily energy expenditure and air temperature. Reprinted (with permission) from Sawka et al. ().
Figure 4. Figure 4. Predictions of daily sodium requirements as a function of daily energy expenditure and air temperature. Reprinted (with permission) from Sawka et al. ().
Figure 5. Figure 5. Two standard schemes for the role of baroreflexes and the renin‐angiotensin‐aldosterone axis in maintaining blood volume. Reprinted (with permission) from Rowell ().
Figure 6. Figure 6. Diagram illustrating the multiple stimulating and attenuating factors involved in thirst and voluntary fluid intake.
Figure 7. Figure 7. Proposed mechanisms of water and solute absorption. Active sodium and glucose cotransport by the SGLT1 transporter in the enterocyte brush border membrane and extrusion of sodium and glucose across the basolateral membrane stimulate water and solute absorption through both transcellular and paracellular routes. The roles of GLUT5, GLUT2, DRTS, Na+‐K+ ATPase, and aquaporins (AQP) are also depicted. Following activation of SGLT1, solutes such as monosaccharides, minerals, and perhaps even small peptides and oligosaccharides can be absorbed via the paracellular pathway. Reprinted (with permission) from Murray and Shi ().
Figure 8. Figure 8. Cardiac output, heart rate, stroke volume, and forearm blood flow during 120 min of cycling (62%‐67% VO2max) in the heat (33°C, 50% rh) when no fluid or small (0.58 L), moderate (1.42 L), or large (2.38 L) volume of fluid was ingested, which induced 4.2%, 3.4%, 2.3%, and 1.1% hypohydration, respectively. Values are means ± SE for 8 different endurance‐trained cyclists. *Significantly different from no fluid, P < 0.05. † Significantly different from small volume of fluid, P < 0.05. § Significantly different from moderate fluid volume of fluid, P < 0.05. Reprinted (with permission) from Montain and Coyle ().
Figure 9. Figure 9. Esophageal temperature during 120 min of cycling (62%‐67% VO2max) in the heat (33°C, 50% rh) when no fluid or small (0.58 L), moderate (1.42 L), or large (2.38 L) volume of fluid was ingested, which induced 4.2%, 3.4%, 2.3%, and 1.1% hypohydration, respectively. Values are means ± SE for 7 endurance‐trained cyclists. *Significantly lower than no fluid, P < 0.05. † Significantly lower than small volume of fluid, P < 0.05. §Significantly lower than moderate fluid volume of fluid, P < 0.05. Reprinted (with permission) from Montain and Coyle ().
Figure 10. Figure 10. Rating of perceived exertion during 120 min of cycling (62%‐67% VO2max) in the heat (33°C, 50% rh) when no fluid or small (0.58 L), moderate (1.42 L), or large (2.38 L) volume of fluid was ingested, which induced 4.2%, 3.4%, 2.3%, and 1.1% hypohydration, respectively. Values are means ± SE for 7 endurance‐trained cyclists. *Significantly lower than no fluid, P < 0.05. †Significantly lower than small volume of fluid, P < 0.05. Reprinted (with permission) from Montain and Coyle ().
Figure 11. Figure 11. Gastric emptying characteristics of test beverages with various % carbohydrate. *Significantly different from all other beverages. Reprinted (with permission) from Murray et al. ().
Figure 12. Figure 12. Net water movement in relation to mean osmolality in the test segment. Data points are means from six to eight subjects each. The upper regression line shows three solutions containing one transportable carbohydrate (○), while the bottom regression line is from six solutions containing two or three transportable carbohydrates (•). The middle line represents the correlation for all nine solutions. Net water absorption increases as osmolality decreases, but at any given osmolality, absorption is greater with solutions containing more than one carbohydrate. Reprinted (with permission) from Shi et al. ().
Figure 13. Figure 13. Cumulative urine output over time after rehydration from exercise‐induced dehydration with ingestion of fixed volume of glucose‐electrolyte drinks containing various sodium concentrations. Reprinted (with permission) from Maughan et al. ().
Figure 14. Figure 14. Net fluid balance during rehydration with different beverage sodium concentrations (23 or 61 mmol/L) and fluid intake volumes (50%, 100%, 150%, or 200% of fluid losses). Reprinted (with permission) from Shirreffs et al. ().


Figure 1. Effect of no water vs. ad libitum water intake vs. water intake to match sweat losses on rectal temperature during marching in the heat (37.8°C, 35%‐45% relative humidity) in 1 male subject. Reprinted (with permission) from Pitts et al. ().


Figure 2. Body fluid compartments that comprise 42 L of total body water in a 70 kg human, and sources of fluid gain or loss. Reprinted (with permission) from Armstrong ().


Figure 3. Predictions of daily water requirements as a function of daily energy expenditure and air temperature. Reprinted (with permission) from Sawka et al. ().


Figure 4. Predictions of daily sodium requirements as a function of daily energy expenditure and air temperature. Reprinted (with permission) from Sawka et al. ().


Figure 5. Two standard schemes for the role of baroreflexes and the renin‐angiotensin‐aldosterone axis in maintaining blood volume. Reprinted (with permission) from Rowell ().


Figure 6. Diagram illustrating the multiple stimulating and attenuating factors involved in thirst and voluntary fluid intake.


Figure 7. Proposed mechanisms of water and solute absorption. Active sodium and glucose cotransport by the SGLT1 transporter in the enterocyte brush border membrane and extrusion of sodium and glucose across the basolateral membrane stimulate water and solute absorption through both transcellular and paracellular routes. The roles of GLUT5, GLUT2, DRTS, Na+‐K+ ATPase, and aquaporins (AQP) are also depicted. Following activation of SGLT1, solutes such as monosaccharides, minerals, and perhaps even small peptides and oligosaccharides can be absorbed via the paracellular pathway. Reprinted (with permission) from Murray and Shi ().


Figure 8. Cardiac output, heart rate, stroke volume, and forearm blood flow during 120 min of cycling (62%‐67% VO2max) in the heat (33°C, 50% rh) when no fluid or small (0.58 L), moderate (1.42 L), or large (2.38 L) volume of fluid was ingested, which induced 4.2%, 3.4%, 2.3%, and 1.1% hypohydration, respectively. Values are means ± SE for 8 different endurance‐trained cyclists. *Significantly different from no fluid, P < 0.05. † Significantly different from small volume of fluid, P < 0.05. § Significantly different from moderate fluid volume of fluid, P < 0.05. Reprinted (with permission) from Montain and Coyle ().


Figure 9. Esophageal temperature during 120 min of cycling (62%‐67% VO2max) in the heat (33°C, 50% rh) when no fluid or small (0.58 L), moderate (1.42 L), or large (2.38 L) volume of fluid was ingested, which induced 4.2%, 3.4%, 2.3%, and 1.1% hypohydration, respectively. Values are means ± SE for 7 endurance‐trained cyclists. *Significantly lower than no fluid, P < 0.05. † Significantly lower than small volume of fluid, P < 0.05. §Significantly lower than moderate fluid volume of fluid, P < 0.05. Reprinted (with permission) from Montain and Coyle ().


Figure 10. Rating of perceived exertion during 120 min of cycling (62%‐67% VO2max) in the heat (33°C, 50% rh) when no fluid or small (0.58 L), moderate (1.42 L), or large (2.38 L) volume of fluid was ingested, which induced 4.2%, 3.4%, 2.3%, and 1.1% hypohydration, respectively. Values are means ± SE for 7 endurance‐trained cyclists. *Significantly lower than no fluid, P < 0.05. †Significantly lower than small volume of fluid, P < 0.05. Reprinted (with permission) from Montain and Coyle ().


Figure 11. Gastric emptying characteristics of test beverages with various % carbohydrate. *Significantly different from all other beverages. Reprinted (with permission) from Murray et al. ().


Figure 12. Net water movement in relation to mean osmolality in the test segment. Data points are means from six to eight subjects each. The upper regression line shows three solutions containing one transportable carbohydrate (○), while the bottom regression line is from six solutions containing two or three transportable carbohydrates (•). The middle line represents the correlation for all nine solutions. Net water absorption increases as osmolality decreases, but at any given osmolality, absorption is greater with solutions containing more than one carbohydrate. Reprinted (with permission) from Shi et al. ().


Figure 13. Cumulative urine output over time after rehydration from exercise‐induced dehydration with ingestion of fixed volume of glucose‐electrolyte drinks containing various sodium concentrations. Reprinted (with permission) from Maughan et al. ().


Figure 14. Net fluid balance during rehydration with different beverage sodium concentrations (23 or 61 mmol/L) and fluid intake volumes (50%, 100%, 150%, or 200% of fluid losses). Reprinted (with permission) from Shirreffs et al. ().
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Lindsay B. Baker, Asker E. Jeukendrup. Optimal Composition of Fluid‐Replacement Beverages. Compr Physiol 2014, 4: 575-620. doi: 10.1002/cphy.c130014