ArticlePDF Available

Effects of Electrolyte Beverage on Preventing Dehydration among Workers in Different Environmental Temperature


Abstract and Figures

Background and Objectives Water and electrolyte balance is important to maintain cognitive and physical performance, especially in hot environment. This study aims to evaluate the effects of two different type of fluid intake at the workplace in preventing dehydration among male workers working in a hot and conveniently cool environment.Methods and Study DesignThis randomized double-blinded placebo controlled trial study was performed in two appointed factories in West-Java in January-February 2012. Seventy-eight healthy male subjects, age 25-45 years were selected and they were grouped based on their working environmental temperature, i.e. hot and conveniently cool environment. The subjects were randomly allocated in two intervention phases by using crossover approach, to have non-electrolyte beverage (plain water) and electrolyte drink in the workplace for 2 days, respectively. Hydration and electrolyte biomarkers were collected from blood and urine samples at before and after the intervention.Results and Conclusions:At baseline, subjects of the hot environment workplace had higher daily working hours, hemoglobin, hematocrit, blood viscosity, and blood sodium concentration as compared to those of conveniently cool environment (P<0.05). After the intervention, for the subjects in hot environment alone, there were significantly lower value of blood viscosity, hemoglobin, and hematocrit, but significantly higher value for blood sodium, USG (urine specific gravity), pH, urinary sodium, urinary potassium and urinary chloride (P<0.05), among subjects having the electrolyte drink as compared to the plain water. In conclusion, this study confirmed that consumption of electrolyte beverage during working in hot environment temperature could help improve hydration status and electrolyte concentration.
No caption available
No caption available
No caption available
Content may be subject to copyright.
World&Nutrition&Journal&|eISSN&2580-7013& &
Corresponding author:
Ermita I. Ibrahim Ilyas
Department of Medical Physiology Medical Faculty
of Medicine, Universitas Indonesia
Email address :
1. Department of Medical Physiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia##
2. Department of Nutrition Medical Faculty Universitas Indonesia Cipto Mangunkusumo General
3. Medical Research Unit, Medical Faculty, Universitas Indonesia
Introduction:& .E570( EF2( 717850/1G57( ?E1EF87( 9M( 9>D/05EF5( 5/( >E9F5E9F( 8/TF959:7( EF2( D<GM98E1(
D70U/0>EF87C( 7MD789E11G( 9F( </5( 7F:90/F>7F53( V<9M( M542G( E9>72( 5/( 7:E14E57( 5<7( 7UU785M( /U( 5O/(
29UU707F5( 5GD7( /U( U1492( 9F5EH7( E5( 5<7(O /0HD1E87( 9F( D07:7F59FT( 27<G20E59/F( E>/FT( >E17( O/0H70M(
Methods:& V<9M( 0EF2/>9W72( 2/4?17R?19F272( D1E87?/( 8/F50/1172(509E1( M542G( OEM( D70U/0>72(9F( 5O/(
EDD/9F572(UE85/097M( 9F(.7M5R6E:E(9F(6EF4E0GRS7?04E0G(@A;@3( N7:7F5GR79T<5(<7E15<G(>E17(M4?X785MC(
57>D70E5407C(9373(</5(EF2(8/F:7F97F51G(8//1(7F:90/F>7F53(V<7( M4?X785M( O707( 0EF2/>1G( E11/8E572(
9F( 5<7( O/0HD1E87( U/0( @( 2EGMC( 07MD 7859:71G3( QG20E59/F( EF2( 717850/1G57( ?9/>E0H70M( O707( 8/117 8572(
Results:&&5( ?EM719F7C(M4?X785M(/U(5<7(</5( 7F:90/F>7F5(O/0HD1E87(<E2( <9T<70(2E91G(O/0H9FT(</40MC(
<7>/T1/?9FC(<7>E5/8095C( ?1//2(:9M8/M95GC(EF2( ?1//2(M/294>(8/F87F50E59/F( EM(8/>DE072(5/(5</M7(
/U( 8/F:7F97F51G(8//1( 7F:90/F>7F5( [D]A3AJ\3( &U570( 5<7( 9F570:7F59/FC( U/0( 5<7( M4?X785M( 9F( </5(
7F:90/F>7F5( E1/F7C( 5<707( O707( M9TF9U98EF51G( 1/O70( :E147( /U( ?1//2( :9M8/M95GC( <7>/T1/?9FC( EF2(
<7>E5/8095C( ?45( M9TF9U98EF51G( <9T<70( :E147( U/0( ?1//2( M/294>C( ^N$( [409F7( MD789U98( T0E:95G\C( DQC(
409FE0G( M/294>C( 409FE0G( D/5EMM94>( EF2( 409FE0G( 8<1/0927( [D]A3AJ\C( E>/FT( M4?X785M( O</( <E2(5<7(
Dehydration is a condition of body water deficit. In
general, according to the research by The
Indonesian Regional Hydration Study (THIRST)
held on 2009, 46.1% of population in Indonesia had
mild dehydration.1 In a physical work setting,
dehydration may result from the excessive sweat
output compared to the water intake. Hydration in
the work place became a special issue in which it
can affect productivity, safety, and cost.
Physical work increases heat production in
the body which needs to be dissipated out from the
body to achieve body heat balance.2 In a warm
environment, excess of metabolic heat is dissipated
to the environment by combination of conduction,
convection, radiation, and evaporation of the sweat.
When the environmental temperature approaches
and exceeds the skin temperature, dry heat loss (by
conduction, convection, and radiation) diminishes
and is replaced by the ‘heat gain’. In that condition,
the only available heat loss mechanism is by sweat
evaporation, and the sweat rate increases.3 Severity
of sweat losses during work in a hot environment is
dependent primarily on work intensity and
duration. Sweating draws water from vascular,
interstitial, and extra-cellular fluid compartments
resulting in the secretion of hypotonic sweat.
Metabolic heat production is balanced by both dry
and evaporative (sweating) heat loss, but very high
metabolic rates coupled with warm weather
demands a larger thermal requirement for
evaporative cooling, leading to greater sweat losses
and subsequently larger water requirement.
It is widely known that water and
electrolyte balance is very important to be
continuously maintained to sustain cognitive and
physical performance. Body water deficit results
from hot weather and/or low water consumption,
even as much as two percent of body weight, may
impair physical and/or work performance. Any
water deficit will affect performance in athlete or
worker and lead to altered physical function and
health. Therefore, an adequate level of hydration is
essential. The possibility of water and electrolyte
losses through sweating should be put into
consideration for people working in hot
environments. Electrolyte beverage usually
contains water, electrolytes such as sodium,
potassium, calcium, and carbohydrate as well. The
addition of electrolytes to ingested water will keep
the plasma electrolyte concentration and osmolality
stable thus the water diuresis can be avoided.
Electrolyte beverage has been reported to be more
effective in retaining water in the body and
preventing hemoconcentration than plain water.
Ingestion of plain water will cause voluntary
dehydration due to decrease of the osmolality that
lead to stimulate the water diuresis. Chang et al.4
in 2010, reported that the recovery from high blood
viscosity induced by dehydration was faster with
electrolyte beverage consumption than with plain
water or tea. A strong correlation between
hematocrit and blood viscosity suggests that fluid
retained in the body reduced the hemoconcentration
and blood viscosity.4 In our preliminary study
showed that workers in two factories, with different
environment which are hot and conveniently cool
environment were prone to dehydration. We found
that hemoglobin concentration, hematocrit, blood
viscosity and blood sodium concentration of
workers in hot environment were significantly
higher than workers in conveniently cool
This present study was performed to
evaluate the effect of electrolyte beverage in
preventing dehydration from workers, especially
noted from clinical symptoms and laboratory
measurements (hemoglobin, hematocrit, blood
viscosity, blood and urine minerals, urine specific
gravity and pH) and to compare the effects of
electrolyte beverage and plain water in preventing
dehydration in workers in real work setting. It is
very important to prevent worker from dehydration
and to protect or reduce the risk of having
cardiovascular problem which can be caused by
hemoconcentration and high blood viscosity. This
study hopefully could give information needed in
the occupational field settings with workers who
work in a hot and conveniently cool environment,
who are considered to be at risk of dehydration that
might lower their productivity. Therefore, the
management departments may obtain some insights
from this research to overcome this problem.
Study Design
The study was a crossover, randomized, double-
blinded placebo controlled trial involving
apparently healthy male subjects workers age 25–
45 years old, working minimally for 8 hours per-
day in two selected manufactures in Cibitung,
West-Java. They did not have renal disease and
diabetes mellitus, and willing to participate in the
study by signing the informed consent.
We could not find any references on the
difference effect of electrolyte drink versus the
drinking water on hydration status and electrolytes
concentration. Therefore this study was conducted
as a preliminary study to have 40 subjects for each
environment condition or minimal 80 subjects for
the total sample.
After signing the informed consent, the
selected subjects were classified according to their
environmental temperature, i.e. the hot and
conveniently cool environments, which were
determined by room temperature measurement
(36–38°C versus 20–22 °C, respectively). Subjects
working in hot environment were those working
close to the heat. Subjects working in conveniently
cool environment were those doing the
administration task in the office facilitated with air
conditioner. The subjects of each environment
temperature were randomly allocated into two
different interventions by using crossover
approach, in which each subject acted as his own
control (Figure 1). Then, each subject will get both
interventions for two days period. Subjects were
advised to consume 300 mL of the provided fluid
every 30 minutes for those working in hot
environment and every hour for those working in
the conveniently cool environment. Each subject
had two days of non-electrolyte beverage (plain
water) and, after the crossover, had two days of
electrolyte beverage as well. These drinks were
provided during 8-hours working period in 4 days
of intervention (the subjects can have ad libitum
drink), served personally in similar shape and color
glasses. The total fluid intake was recorded through
measuring the left over drink. During the
intervention, lunch and break time snacks were
provided with calorie contributing to 30-40% of the
total calorie.
Study overview
This study was done at two automobile spare-parts
factories in Cibitung West Java in January to
February 2012. Before starting the recruitment and
including the subjects into the study, informed
consent was asked and recorded. This study
received ethical approval from the Ethics
Committee of the Faculty of Medicine Universitas
Indonesia (No. 30/PT02/FK/ETIK/2012, January
18, 2012). All subjects signed the informed consent
form to show their willingness to participate in the
Data Collection
Subjects were interviewed regarding their socio-
demographic characteristic, employment duration
and medical history. Interview was needed to
clarify the food record as well. Food record method
was used to assess energy intake and was done in 4
consecutive days during the intervention period.
Anthropometric measurements were done before
the intervention, which included body weight and
height to calculate the body mass index. Vital sign
measurements including blood pressure and heart
rates were collected through physical examination.
Blood and urine samples were collected before
intervention to obtain baseline data on hemoglobin,
hematocrit, blood viscosity, blood glucose, renal
function (estimated creatinine-clearance test),
blood and urine electrolytes (sodium, potassium
and chloride), urine color, pH, and urine specific
gravity (USG) by using standardized procedures.
The data was collected again after two days after
the working time during the four days study period
to obtain data on the effect of each of the
Statistical Analyses
Data was recorded using a special form and was
edited, coded, and administered into the working
sheet by using statistical program for social
sciences (SPSS) software version 20. All data was
presented accordingly based on its normality
distribution, and analyzed by using unpaired-T test
or Mann-Whitney test, paired-T test or Wilcoxon
test, and Chi-square or McNemar test.
The recruitment of the subjects started from 6th
January 2012 and ended on 3rd February 2012.
Figure 2A and Figure 2B show the flow of the
intervention and data collection scheme, and we
analyzed 39 subjects receiving both interventions in
each workplace conditions, i.e. hot and
conveniently cool environment.
Before the intervention, this study found
that there were significant differences in several
hydration and electrolytes biomarkers, in which
hemoglobin, hematocrit, blood viscosity and blood
sodium were higher among those working in hot
environment compared to those working in the
conveniently cool environment workplace
(P<0.05), as shown in Table 1. The general
conditions of the subjects in both temperature
workplaces were not affected by the interventions,
as presented in Table 2.
In the blood measurement, there were
significant lower values of blood viscosity,
hemoglobin, hematocrit, and blood sodium
concentration among subjects after receiving
electrolyte drink compared to subjects receiving
plain water for two days, but only among those
working in hot environment workplace, as shown
in Table 3.
However, Table 4 shows that those having
electrolyte drink had significantly higher USG, pH,
urinary sodium, potassium and chloride compared
to those having plain water in which, again, only
found among those working in hot environment
Table 1 General characteristics of the subjects by different workplace environment before interventions
Hot environment
Cool environment
Age, y
29 (2544)^
30 (2545)^
Duration of working, y
8 (122)^
8 (130)^
Working hours/day
12 (812) ^
8 (712) ^
Body weight, kg
Body height, m
1.67 (1.551.87) ^
1.66 (1.571.83) ^
BMI, kg/m2
Hemoglobin, g/dL
15.6 (12.318.0)^
14.8 (12.617.2)^
Hematocrit, %
46 (3949)^
44 (4049)^
Blood viscosity,
Blood sodium,
140 (136145)^
138 (135141)^
Blood pressure, mmHg:
110 (90160)^
120 (80150)^
80 (60100)^
80 (60100)^
BMI, body mass index; USG, urine specific ^median (minimum-maximum); ~mean (SD),
*Mann-Whitney test; **unpaired-t test(
Table 2 General conditions of the subjects by beverage-drink type intake in different workplace environments
General Conditions
Plain water
Electrolyte drink
Plain water
Systolic BP (mmHg)
(100– 140)^
After two days
Diastolic BP (mmHg):
After two days
Heart rate (times/minute):
72 (6088)^
After two days
78 (6084)^
78 (66 84)^
Fluid intake (mL):
After two days
^median (minimum-maximum); ~mean (SD), *Wilcoxon test; **paired-t test+
Table 3 Hydration biomarkers of the subjects taken from blood sample by beverage-drink type intake in different workplace environments
Hydration biomarkers
Plain water
Plain water
Viscosity (mPa.s):
After two days
Changes after baseline
Hemoglobin (mg/dL):
After two days
Changes after baseline
Table 3 (continued)
Hydration biomarkers
Plain water
Plain water
Hematocrit (%):
44 (3948)^
44 (4049)^
After two days
43 (4148)^
44 (3950)^
Changes after baseline
-1.0 (-5–3.0)^
0 (-4–3.0)^
Sodium (mOsm/L):
After two days
Changes after baseline
0 (-3.06.0)^
0 (-3.03.0)^
0 (-3.06.0)^
Potassium (mOsm/L):
4.0 (3.45.0)^
4.0 (3.45.0)^
4.0 (3.66.0)^
4.0 (3.55.0)^
After two days
4.0 (3.24.4)^
4.0 (3.45.0)^
3.8 (3.44.4)^
3.9 (3.34.5)^
Changes after baseline
0 (-1.60.4)^
0 (-1.01.0)^
Table 3 (continued)
Hydration biomarkers
Plain water
Plain water
Chloride (mOsm/L):
After two days
Changes after baseline
0 (-4.04.0)^
0 (-4.03.0)~
0 (-3.03.0)~
^median (minimum-maximum); ~mean (SD), *Wilcoxon test; **paired-t test#
Table 4 Hydration biomarkers of the subjects taken from urine sample by beverage-drink type intake in different workplace environments
Hydration biomarkers
(from urine-sample)
Plain water
Plain water
USG status:
After two days
Changes after baseline
6 (57)^ 6 (57)^ 0.123* 6 (57)^ 6.5 (58)^ 0.664*
After two days 6 (57)^ 6 (58)^ 0.003* 6 (57)^ 6 (57)^ 0.293*
Changes after baseline 0 (-1.01.0)^ 0 (-1.02.0)^ 0.003* 0 (-2.02.0)^ 0.2±0.8~ 0.947*
Normal urine color, n(%):
Table 4 (continued)
Hydration biomarkers
(from urine-sample)
Plain water
Plain water
6 (57)^
6 (57)^
6 (57)^
6.5 (58)^
After two days
6 (57)^
6 (58)^
6 (57)^
6 (57)^
Changes after baseline
0 (-1.01.0)^
0 (-1.02.0)^
0 (-2.02.0)^
Normal urine color, n(%):
32 (82.1)
35 (89.7)
35 (89.7)
33 (84.6)
After two days
39 (100)
36 (92.3)
39 (100)
39 (100)
Sodium (mOsm/L):
(10 - 256)^
After two days
62 (13301)^
Changes after baseline
Table 4 (continued)
Hydration biomarkers
(from urine-sample)
Plain water
Plain water
Potassium (mOsm/L):
After two days
(1.0 51.2)^
Changes after baseline
Chloride (mOsm/L):
After two days
Changes after baseline
^median (minimum-maximum); ~mean (SD),
*Wilcoxon test; **paired-t test; ***McNemar-test
This study aimed to evaluate the effect of
electrolyte beverage in preventing dehydration for
workers, especially noted from clinical symptoms
and laboratory measurements (hemoglobin,
hematocrit, blood viscosity, blood and urine
minerals, urine specific gravity and pH). This
study’s objective was also to compare the effect of
electrolyte beverage and plain water (non-
electrolyte drink) in promoting hydration and
electrolytes balance among the workers in hot and
conveniently cool environment. We tried to keep
the subjects as stated in the protocol of the study,
however, two subjects from the hot environment
and one subject from the cool environment had to
leave due to urgent reasonable reasons (Figure 2A
and Figure 2B).
Based on work environment difference, the
subjects had similar age, however they had
different working hours (Table 1). It was shown
that subjects working in the hot environment had
significantly longer working hours compared to
those working in the cool environment. By working
in a hot environment for a longer period, the risk to
become dehydrated is higher unless the workers are
used to drinking sufficiently. If we could
extrapolate by using an example of very active fire
fighters, then they should have daily water
requirements of about 7 L/day.6
Based on the blood analyses, Table 1 shows
several indices of hydration status. There were
significantly higher hemoglobin concentration,
hematocrit, blood viscosity and blood sodium
among subjects working in hot environment
compared to the subject working in the cool
environment. Particularly, 79.5% of subjects
working in hot environment had high blood
viscosity compared to subjects in the cool
environment (25.6%). These showed that workers
who work in the hot environment are at higher risk
of falling into a dehydration state compared to
those working in the conveniently cool
environment. The sweating process involves the
fluid loss from the extracellular compartment
including fluid from the vascular. Hematocrit can
be described as relationship between the cellular
volume compared to total blood volume. Its level
increases when the total RBC amount increases or
when a person losses fluid which leads to a
decrease of plasma volume, which happens in
sweating process. Working in a hot environment
increases sweat rates which results in decrease of
plasma volume. The blood viscosity increases
along with the increasing hematocrit.7
The most widely investigated are body mass
changes, blood indices, urine indices and
bioelectrical impedance analysis.8 Measurement of
haemoglobin concentration and hematocrit has the
potential to be used as a marker or change in
hydration status. However, Armstrong et al9
(1994) stated that hematologic measurements are
not as sensitive to mild hypohydration as the
certain urinary indices. This perhaps suggests that
plasma volume is defended in an attempt to
maintain cardiovascular stability, and so plasma
variables will not be affected by hypohydration or
dehydration until a certain degree of body water
loss has occurred.
The subjects working in hot environment
had higher sodium level than those working in cool
environment. This higher levels of sodium is
probably caused by two things: first, the water loss
from the skin from sweating process made
extracellular fluid depletion more excessive in the
subjects working in hot environment. Second, the
lower water intake of the subjects in hot
environment might be the cause of this higher
sodium level, which is shown at Tabel 2. As a
primary cation in extracellular fluid (ECF), any loss
of water will increase sodium concentration in ECF
compartment, which in turn will increase plasma
osmolality. Plasma osmolality also provides as a
marker of dehydration level because it is closely
controlled by homeostatic system, thus serving as a
primary physiological signal to regulate water
balance, i.e. changes in urine output and fluid
Plasma or serum sodium concentration and
osmolality will increase when the water loss
inducing dehydration is hypotonic with respect to
plasma. An increase in these concentrations would
be expected, as in many cases of hypohydration,
including water loss by sweat secretion, urine
production or diarrhea. Similar finding was
reported by Armstrong et al9 (1994), which perhaps
suggests that plasma volume is defended in an
attempt to maintain cardiovascular stability. Thus,
plasma variables will not be affected by
dehydration until a certain degree of body water
loss has occurred.
Baseline fluid intake (plain water and
electrolyte beverage) in both groups, as seen in
Table 2, are not significantly different. However,
subjects working in hot environment had higher
daily fluid requirements compared to subjects in
cool environment, because the skin water loss is
higher as well and this condition will increase the
feeling of thirst. The lower water intake of subjects
in hot environment is probably related to water
provision. The water supply for workers in hot
environment was only provided in a rest area which
probably cannot be easily accessed by workers
because they could not leave their work at any time
and they were not provided with a water container
at their work place. On the days of intervention, the
median of water intake reached up to 3607–4142
mL. During the interventions, the fluid intake was
increase because the researchers provided the water
in tumblers which were held in a carrying bag
which then easily accessed and drank by the
workers. As expected, the amounts of fluid
consumptions during the intervention period were
significantly higher among workers in the hot
environment compared to those working in the cool
environment. By providing the fluid at the
workplace and giving easy access to the fluid
supply, the workers in the hot environment
voluntarily increased their fluid consumption which
then significantly increased their total fluid intake.
By providing different types of fluid drink,
i.e. plain water and isotonic drink, this study
showed perceptual factor in relation to voluntary
drinking. As widely known, voluntary drinking of a
beverage is affected by its palatability, which is
determined by its color, flavor, odor, and
temperature.12-17 The sweet flavour of a drink is a
major factor in its palatability. However, in reality,
people’s prefer flavor differ, which depends on
various factors, including ethnicity and cultural
backgrounds. In this study, it was revealed that
there was no difference in the volume of fluid
intake between the two different types of provided
drink (p>0.05) both in the hot and cool
environment workers (Table 2).
As seen in Table 2, there was no significant
change neither in systolic nor diastolic blood
pressure during the intervention in both
environment. Intervention with plain water and
isotonic fluid both could maintain the blood
presssure in a stable condition. Dehydration will
typically lower blood pressure slightly due to lower
blood volume but this happens only in extreme
cases. Extreme overhydration (faster than can be
processed and expelled from the body) can lead to
a raised blood pressure. The body regulates
hormones to keep the blood pressure basically
stable except in extreme cases.18
Heart rate is a vital sign to provide clues to
the presence of many medical conditions. Reflex
changes in heart rate are one of the body’s most
basic mechanisms for maintaining proper perfusion
to the brain and other tissues.19 Perfusion is the
flow of blood through an organ. Low blood volume
caused by bleeding or dehydration results in the
heart beating faster as it attempts to maintain
adequate blood pressure. Excitement, stress, and
anxiety activate the nervous system, which may
also speed the heart rate and raise blood pressure.
Total body water by weight was found to be related
to diastolic blood pressure, r= -0.56, p=0.01.18
Table 3 shows that blood viscosity after
intervention is significantly decreased for subjects
in hot environment because they were potentially
dehydrated induced by the high sweat rates. The
isotonic drink had a lower effect on blood viscosity
than the plain water as the isotonic drink contains
electrolytes which pertains the plasma volume and
avoids water diuresis. Hemoglobin and hematocrit
were different after the intervention on both groups.
However, there was no significant difference
between the workers that drink plain water and
electrolyte beverage. The lower hematocrit level
during intervention suggested more liquid entering
the intravascular space which then lowered the
hematocrit level, in accordance to the relationship
between the cellular volume to the total blood
volume.7 These findings remarked that fluid
replacement, either with isotonic drink or plain
water, could avoid the potential hemoconcentration
during work. While the average blood sodium level
of subjects in hot environment during intervention
period was significantly different between plain
water and electrolyte beverage in hot environment
workers, it is not the same in cool convenient
Both interventions lowered the urine specific
gravity in hot environment setting as the fluids
diluted the urine (Table 4). The administration of
isotonic drink first will produce lower urine
specific gravity because it retained more fluid in
the body. While in the cool environment setting,
both interventions lowered the urine specific
gravity but there was no difference between the
plain water and electrolyte beverage as there were
no fluid losses in this setting. The administration of
both fluids in subjects of hot environment setting
would lower the renal sodium excretion on the first
phase, then the isotonic drink on the second phase
would made an adequate level in the blood thus
excreting more sodium in the urine. In the
conveniently cool setting both intervention lowered
the renal sodium excretion but no difference
between the both fluid. In that setting the isotonic
drink gave no benefit physiologically. Plain water
and isotonic beverage both could maintain the body
water of the subjects in hot environment, as both
could replace the increasing water loss from
sweating process. In the cool environment, the
baseline body water, which was lower than the
counterpart, increased after the administration of
both fluids, but their peak were more prominent
after the administration of isotonic fluid.
In conclusion consuming electrolyte
beverage would prevent male workers aged 25–45
years, especially those working in a hot
environment from dehydration as compared to non-
electrolyte beverage.
Conflict of Interest
Saptawati Bardosono is a one of editors but was not
involved in the review or decision process for this
Open Access
This article is distributed under the terms of the
Creative Commons Attribution 4.0 International
License (,
which permits unrestricted use, distribution, and
reproduction in any medium, provided you give
appropriate credit to the original author(s) and the
source, provide a link to the Creative Commons
license, and indicate if changes were made.
This study was supported by PT Amerta Indah
Otsuka Indonesia.
1. Hardinsyah, Briawan D, Effendi, YH,
Dwiriani CM, Dewi M, Damayanti E, Aries
M 2010, Kebiasaan minum dan dan status
hidrasi pada remaja dan dewasa di dua
wilayah ekologi berbeda, Tim THIRST
(The Indonesian Regional Hydration
FKM UNHAS, Jakarta.
2. Sawka MN, Montain SJ, Latzka WA.
Hydration effects on thermoregulation and
performance in the heat. Comparative
Biochemistry and Physiology Part A:
Molecular & Integrative Physiology 2001
Apr;128(4):679–90. [Google Scholar]
3. Miller VS, Bates GP. Hydration, hydration,
hydration. Annals of occupational hygiene
2009;54(2):134–6. [Google Scholar]
4. Chang CQ, Chen YB, Chen ZM, Zhang LT.
Effects of a carbohydrate-electrolyte
beverage on blood viscosity after
dehydration in healthy adults. Chinese
medical journal 2010;123(22):3220–5.
[Google Scholar]
5. Bardosono S, Ilyas E. Health, nutrition and
hydration status of Indonesian workers: a
preliminary study in two different
environmental settings. Medical Journal of
Indonesia 2014;23(2):112. [Google Scholar]
6. Ruby BC, Shriver TC, Zderic TW, Sharkey
BJ, Burks C, Tysk S. Total energy
expenditure during arduous wildfire
suppression. Medicine and Science in
Sports and Exercise 2002;34(6):1048–54.
[Google Scholar]
7. Karsheva M, Dinkova P, Pentchev I,
Ivanova T. Blood rheology-a key for blood
circulation in human body. Journal of the
University of Chemical Technology and
Metallurgy 2009;44(1):50–4. [Google
8. Shirreffs SM. Markers of hydration status.
European journal of clinical nutrition 2003
Dec;57. [Google Scholar]
9. Armstrong LE, Maresh CM, Castellani JW,
Bergeron MF, Kenefick RW, LaGasse KE,
et al. Urinary indices of hydration status.
International journal of sport nutrition
1994;4(3):265–79. [Google Scholar]
10. Andreoli TE, Reeves WB, Bichet DG 2000,
Endocrin control of water balance, in Fray
JCS, Goodman HM (ed.), Handbook of
Physiology: Endocrin regulation of water
and electrolyte balance, Oxford University
Press, New York, pp. 530–569.
11. Knepper MA, Valtin H, Sands JM 2000,
Renal actions of vasopressin, in Fray JC,
Goodman HM(ed.), Handbook of
Physiology: Endocrin regulation of water
and electrolyte balance, Oxford University
Press, New York, pp. 496–529.
12. Boulze D, Montastruc P, Cabanac M. Water
intake, pleasure and water temperature in
humans. Physiology & behavior
1983;30(1):97-102. [Google Scholar]
13. Hubbard RW, Sandick BL, Matthew WT,
Francesconi RP, Sampson JB, Durkot MJ,
et al. Voluntary dehydration and alliesthesia
for water. Journal of Applied Physiology
1984;57(3):868–73. [Google Scholar]
14. Meyer F, Bar-Or O, Salsberg A, Passe D.
Hypohydration during exercise in children:
effect on thirst, drink preferences, and
rehydration. International Journal of Sport
Nutrition 1994;4(1):22–35. [Google
15. Szlyk PC, Sils IV, Francesconi RP,
Hubbard RW, Armstrong LE. Effects of
water temperature and flavoring on
voluntary dehydration in men. Physiology
& behavior 1989;45(3):639–47. [Google
16. Wilk B, Bar-Or O. Effect of drink flavor
and NaCl on voluntary drinking and
hydration in boys exercising in the heat.
Journal of Applied Physiology
1996;80(4):1112–7. [Google Scholar]
17. Zellner DA, Bartoli AM, Eckard R.
Influence of color on odor identification and
liking ratings. The American journal of
psychology. 1991 Dec 1:547–61.#
18. Musini VM, Wright JM. Factors affecting
blood pressure variability: lessons learned
from two systematic reviews of randomized
controlled trials. PLoS One. 2009 May
19. Suhr JA, Patterson SM, Austin AW,
Heffner KL. The relation of hydration status
to declarative memory and working
memory in older adults. J Nutr Health
Aging 2010;14(10):840–3. [Google
20. Karsheva M, Dinkova P, Pentchev I,
Ivanova T. Blood Rheology - A Key for
Blood Circulation in The Human Body.
Journal of The University of Chemical
Technology and Metallurgy 2009;44(1):50–
4. [Google Scholar]
... the meta-analysis and review of 26 studies showed that high fluid intake in the Asia population has protective effect against bladder cancer (Liu et al., 2017). Good Hydration also gives a beneficial effect on exercise performance and routine activities (Ali et al., 2018;Ilyas et al., 2018). However, people in Spain, France, Turkey, Iran, Indonesia, and China intake water in range 0.76 to 1.78 L/day, lower than the recommendation (Guelinckx et al., 2015). ...
... Aroma, bottle shape, colour of the fluid, nutritional information, mouth-feel and taste, affect the sports drink consumption of sports drinks ( Coombes, 2005 ). When compared to water, consumers find sports drinks more appealing and consider them more beneficial in terms of electrolytes, minerals, and physical performance ( Ilyas et al., 2018;Karelis et al., 2010 ). Recent reports indicate that regular sports drinks consumption has significant positive relationships with cigarette use, increased daily intake of sugar-sweetened soft drinks, fruit drinks and 100% fruit juice, other beverage intake, media use, video game use and lower occurrences of eating breakfast ( Larson et al., 2014 ). ...
By the year 2020, the sports drinks segment in the global beverage industry is expected to reach US$6B. In an alternate segment, bottled water is the main competitor. Sports drinks marketing continues to focus on unproven benefits such as attention, increased performance during sport, increased energy and stamina. Both categories claim their product is the healthier alternative to the other. Yet there has been limited, if any, research on the effects of the perceived taste of sports drinks, familiarity with the brand, nutrition involvement and colour cue perceptions on sports drink consumption. Study 1 explored the perceived healthiness of sports drinks based on colour cues. The results showed that based on colour alone, clear coloured sports drinks are considered the healthiest. Study 2 explored dual-stage moderated mediation effects of familiarity with the brand, nutrition involvement and clear colour on the perceived taste and sports drink consumption relationship. The results showed that if sports drinks are perceived to be flavourful, delicious and good tasting; then consumers' are more likely to consume greater quantities of it. Furthermore, familiarity with the brand mediates the relationship between perceived taste and sports drink consumption. Moreover, interaction effects of nutrition involvement and clear colour, results in a dual stage moderated mediation which has positive, direct and indirect effects on sports drink consumption. This study will assist marketers to shift their marketing tactics in terms of the way they promote the healthiness of sports drinks, from the physiological benefits to more cognitive based benefits.
Hydration status is a significant component to keep the functions of bodywork system. Memory is one of the cognitive brain functions which enables human to do daily activities optimally. The purpose of this study was to determine the correlation between hydration status and memory in nursing students. This research employed a comparative analytical method and involved 152 students. The measurement of hydration status was carried out by calculating urine specific gravity using a urinometer while the Everyday Memory Questionnaire (EMQ) was used to measure memory. The independent t-test employed to identify the relationship between hydration status and memory. This research reveals that there is a significant difference between the value of average memory score in students who do not suffer from dehydration and that in students who suffer from dehydration (p = 0.003; t = 3.040). Maintaining the balance of dehydration status is crucial to make the memory work optimally.
Full-text available
Background: Hydration status in the working environment of hot and conveniently cool may influence the health status of workers, including their hydration status. This study aimed to determine the health, nutrition and hydration status of workers in two different working environment, i.e. hot and conveniently cool environment.Methods: A cross-sectional comparative study was done on apparently healthy male subjects, age 25-45 years. Two groups of factory workers consisted of 39 subjects working in environment exposed directly to heat and the other doing administrative work in cool environment. Data on their health status (physical examination), weight, height, waist circumference, fat body composition, laboratory result, were collected. The data was presented as average value and proportion; statistical analysis with unpaired-t (Mann-Whitney test) and chi-square test was used.Results: Subjects working in a hot environment were more prone to dehydration in comparison to their counterparts, as was shown by significantly higher values of several hydration status biomarkers: hemoglobin (15.6 vs 14.8 g/dL, p = 0.017), hematocrit (46 vs 44.5%, p = 0.040), blood viscosity (23 vs 12 mEq/L, p < 0.001), and blood sodium concentration (140 vs 138 mEq/L, p < 0.001). In contrast, subjects working in a conveniently cool environment who did more administrative tasks were physically less active, had significantly lower HDL-cholesterol level (43 vs 52.1 mg/dL, p = 0.005), higher body and visceral fat compositions (21.6 vs 17.6%, p = 0.008, and 10 vs 8%, p = 0.015, respectively) compared to their counterparts.Conclusion: Workers in hot and cool working environment are prone to nutrition- and health problems as well as dehydration, suggesting special attention to the provision of timely drinking water, and physical activity during working time.
Full-text available
In the present work the rheological behaviour of the whole blood of healthy persons in relation to its parameters (hematocrite, hemoglobin and RBC) was investigated. It was found that the whole blood exhibits non-Newtonian behaviour which can be described by the power law rheological model. The blood apparent viscosity in women is lower than that in men which can be explained by lower HCT values for the females. The observed HCT values are not always directly related to the erythrocytes number it depends also on the RBC dimensions. The dependencies of the rheological param-eters K and n on the hematocrite values are found. Both dependencies could be described by linear relationship with HCT. The dependencies of the rheological parameters on the RBC concentration are also found. The dependency of K on RBC could be described by 2 nd degree polynomial relationship. On the other hand the flow index values are almost unaffected by the erythrocytes’ concentration. So it could be taken a mean value for n.
Full-text available
Prior studies have suggested a relationship between dehydration and poor cognitive performance. The present study examined the relationships among hydration status, declarative memory and working memory skills, and blood pressure in a sample of older community dwelling females. Data was analyzed from a larger study; relationships among hydration status, blood pressure, and cognitive measures were assessed with correlation and meditational analyses. Laboratory. 21 postmenopausal women (mean age 60.3, SD 8.03). Hydration status was measured using bioelectrical impedance, baseline blood pressure was assessed using a Colin Pressmate, and cognition was examined using the Auditory Verbal Learning Test and Auditory Consonant Trigrams. Bioelectrical impedance total body water by weight was found to be related to working memory, r = .47, p = .04, and memory skills, r = .54, p = .01. Total body water by weight was also found to be related to diastolic blood pressure, r = -.56, p = .01, which in turn was related to working memory, r = -.67, p = .002, and declarative memory, r = -.57, p = .009, skills. When diastolic blood pressure was accounted for, the relationship between hydration status and cognitive skills was attenuated. A similar pattern of results was seen for systolic blood pressure, although findings did not reach statistical significance. Results emphasize the importance of considering hydration status and blood pressure when interpreting cognitive performance in older adults.
Full-text available
Throughout the world, large numbers of manual workers perform physically demanding labour in conditions of high environmental heat stress. Although the importance of adequate hydration in combating heat stress is universally recognized, studies in a range of worker groups have demonstrated a disturbingly poor hydration level in a high proportion of at-risk workers. Management of work in hot environments traditionally focuses on environmental monitoring, while strategies to promote and ensure good hydration behaviour are often haphazard at best. An example is given of simple guidelines for adequate and appropriate fluid intake and practical recommendations to foster compliance.
Full-text available
Systematic reviews can often reveal much more than the original objective of the work. The objectives of this retrospective analysis were to answer three basic questions about blood pressure variability: 1) Does blood pressure entry criterion have an effect on baseline blood pressure variability? 2) Do thiazide diuretics have a significant effect on blood pressure variability? and 3) Does systolic blood pressure vary to the same degree as diastolic blood pressure? This analysis of blood pressure variability is based on resting standardized research setting BP readings from two systematic reviews evaluating blood pressure lowering efficacy of thiazide diuretics from double blind randomized controlled trials in 33,611 patients with primary hypertension. The standard deviation reported in trials was the focus of the research and the unit of analysis. When a threshold systolic or diastolic blood pressure value is used to determine entry into a trial, baseline variability is significantly decreased, systolic from 14.0 to 9.3 mmHg and diastolic from 8.4 to 5.3 mmHg. Thiazides do not change BP variability as the standard deviation and coefficient of variation of systolic blood pressure and diastolic blood pressure did not differ between thiazide and placebo groups at end of treatment. The coefficient of variation of systolic blood pressure was significantly greater than the coefficient of variation of diastolic blood pressure. Entry criterion decreases the baseline blood pressure variability. Treatment with a thiazide diuretic does not affect blood pressure variability. Systolic blood pressure varies to a greater degree than diastolic blood pressure.
The sections in this article are: Vasopressin and the Urinary Concentrating and Diluting Mechanism General Features of the Urinary Concentration and Dilution Process Mechanism of Tubule Fluid Dilution Mechanism of Tubule Fluid Concentration Countercurrent Multiplication Role of Vasopressin in Urinary Concentration and Dilution Vasopressin Receptors V1a and V1b Receptor Subtypes V2 Receptors Renal Localization Regulation of Aquaporin Water Channels by Vasopressin Aquaporin Structure Localization of Aquaporins in the Kidney Short‐ and Long‐Term Regulation of Water Permeability in the Collecting Duct Short‐Term Regulation of Aquaporin‐2 by Vasopressin‐Induced Trafficking Long‐Term Regulation of Water Transport Through Regulation of Aquaporin Protein Abundance Role of Vasopressin in Pathophysiological Stales Associated with Abnormalities of Water Balance The Vasopressin‐Regulated Urea Transporter Physiological Evidence for a Vasopressin‐Regulated Urea Transporter Molecular Cloning of Renal Urea Transporters Short‐Term Regulation Long‐Term Regulation Regulation of Loop of Henle Function by Vasopressin Thick Ascending Limb Thin Ascending Limb Regulation of Renal Hemodynamics by Vasopressin Medullary Blood Flow Glomerular Function
The sections in this article are: The Water‐Repletion Reaction Cell‐Volume Regulation The Neurohypophysis Structure Hormone Biosynthesis, Transport, and Metabolism Control of Antidiuretic Hormone Release Osmotic Regulation Nonosmotic Regulation Chemical Mediators Intranuclear Secretion Oxytocin Thirst Osmotic Regulation Volume‐Mediated Thirst Satiation of Thirst Renal Contribution to Osmotic Homeostasis Renal Countercurrent Mechanisms Effects of Filtration Rate and Solute Excretion Collecting Tubule Medullary Thick Ascending Limb of Henle Integration of Antidiuretic Hormone Actions with the Urinary Concentrating Mechanism Selected Clinical Derangements of Water Balance Hypertonic Syndromes Hypotonic Syndromes
The consumption of carbohydrate-electrolyte beverages (CEs) has been known to be more effective than plain water for recovery from dehydration. This phenomenon suggests that the ingestion of CEs after dehydration is better than water for maintaining body fluid and plasma volume, and for the recovery from hemoconcentration and high blood viscosity as well. High blood viscosity causes infarction and other cardiovascular events. In this study, CE was compared with water and tea for the ability to reduce increased blood viscosity after dehydration. A crossover random control study was conducted to assess the effectiveness of three beverages for rehydration and decreasing of blood viscosity. Following exercise-induced dehydration of 2.2% of body weight in a permanent warm environment, 10 male subjects rested in a thermoneutral environment for 3 hours (rehydration period, REP). The subjects ingested test beverages equal to their body weight loss during the first 20 minutes in REP. Blood and urine samples were obtained throughout the experiments to assess the rehydration effect. The change in blood viscosity at a shear rate of 5/s was significantly lower in CE ((-1.66 ± 0.21) mPa×s) in comparison to water ((-0.95 ± 0.26) mPa×s) or tea ((-0.92 ± 0.14) mPa×s) at 60th minute during the REP. The fluid retention rate was significantly greater for CE ((77.0 ± 3.9)%) than water ((61.2 ± 3.4)%) and tea ((60.5 ± 3.7)%) for 3 hours of rest in REP. The recovery from high blood viscosity induced by dehydration was higher with CE consumption than with water or tea. These results suggest that CE is useful for normalizing increased blood viscosity due to exercise-induced dehydration.
The effects of color on odor identification were tested under color appropriate, inappropriate, and blindfolded conditions. Subjects made fewer errors in identifying solutions that were colored appropriately (e.g., red-cherry) than in either the blindfolded condition, where there were no color cues, or the inappropriate color condition (e.g., red-lemon). Identification accuracy was greatest for typical odor-color combinations (e.g., red-cherry) compared with appropriate but nontypical odor-color combinations (e.g., red-watermelon). Response latencies were fastest for odors in the appropriately colored solutions. Subjects also rated appropriate color-odor combinations as most pleasant. However, this effect is probably due to the increase in identification accuracy of the appropriately colored solutions. In all three conditions, correctly identified odors were liked more than odors that were not correctly identified. Thus, color is an important perceptual variable in odor identification because it biases subjects toward a color category that facilitates identification if the color is "correct". This ability to identify an odor in turn influences the affective response to the odor.
Effects of water temperature and flavoring on fluid consumption and body weight losses were studied in fourteen unacclimatized men (21-33 years) during 6 hr of treadmill exercise (4.8, 5% grade for 30 in a hot environment. Subjects consumed each of four beverages (15 degrees C water, 40 degrees C water, 15 degrees C flavored water, and 40 degrees C flavored water) on four nonconsecutive days. We identified two groups of individuals by body weight (BW) loss during the cool water trial: drinkers (D) who lost less than 2% initial BW (0.80 +/- 0.15%) and reluctant drinkers (RD) who lost more than 2% (2.53 +/- 0.12%). Although sweat losses were not different between the two groups, D consumed 31% more cool water than RD and experienced 68% less BW loss. Compared to the warm water trial, 6 hr consumption of cool water was significantly increased in both D (59%) and RD (141%) and BW loss was dramatically reduced in both groups. Flavoring significantly enhanced warm water consumption and reduced BW loss in RD only. Reduced consumption of warm water increased rectal temperature, heart rate and plasma osmolality in both groups. The results of this study indicate that either flavoring or cooling warm water will enhance fluid intake and reduce body weight deficits in men reluctant to drink.