The Influence of Fluid Intake on Mental Performance
Does Altering Daily Fluid Intake and Hydration Status Influence Cortisol Reactivity to Acute Psychosocial Stress?
Over half of the adult population in Europe, Asia and Latin America fail to meet adequate water intake guidelines as advised by the European Food Safety Authority (EFSA; 2.5 and 2 litres/day for men and women, respectively coming from both food and drinks). Increasing epidemiological evidence suggests that chronic low fluid intake may be associated with an increased risk of cardiovascular, metabolic, and renal diseases. The association between chronic low fluid intake and increased morbidity risk may be underpinned by elevations in key water-regulating hormones, such as arginine vasopressin (AVP) and its surrogate copeptin, which influence glucose regulation and renal function. For example, AVP stimulates the hypothalamic-pituitary adrenal (HPA) axis to release the stress hormone cortisol with potentially far-reaching effects on metabolism, immunity and inflammation. Prospective cohort studies have demonstrated that exaggerated cortisol responses to acute stress are associated with poor health outcomes.
A recent cross-sectional study (NCT05491122) from our group found that individuals with a low habitual fluid intake experienced greater cortisol reactivity to acute stress than those with a high habitual intake. The findings of this study may provide a potential explanation for why poor hydration and low fluid intake have negative effects on long-term health. We now aim to explore whether altering fluid intake influences cortisol reactivity to acute stress.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: William J Searle, PhD
- Phone Number: 01519041031
- Email: w.j.searle@ljmu.ac.uk
Study Contact Backup
- Name: Harry K W Bell, MSc
- Email: h.k.bell@ljmu.ac.uk
Study Locations
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Liverpool, United Kingdom
- Recruiting
- Liverpool John Moores University
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Contact:
- William J Searle, PhD
- Phone Number: 01519041031
- Email: w.j.searle@ljmu.ac.uk
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Contact:
- Harry K Bell, MSc
- Email: h.k.bell@ljmu.ac.uk
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Sub-Investigator:
- William J Searle, PhD
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Sub-Investigator:
- Harry K Bell, MSc
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Sub-Investigator:
- Danielle H McQueen, MSci
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Principal Investigator:
- Neil P Walsh, PhD
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Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Individuals who…
- …are free-living, who fully understand and agree to the objectives of the study, who gave, signed and dated informed consent, which includes compliance with the requirements and restrictions listed in the informed consent form and in this protocol.
- …are 'healthy' men and current combined oral contraceptive (COC)-using women (having taken the COC for at least 3 months and should they be eligible and willing to participate, are happy to continue taking the same COC during the duration of their participation).
- …are aged 18-35 years
- …engage in < 5 hours of vigorous exercise a week. This information will be obtained during the initial study brief and using the health screening questionnaire.
- …have a habitual fluid consumption of ≤ 1.6 L/day OR ≥ 2.9 L/day for men and ≤ 1.5 L/day OR ≥ 2.5 L/day for women, verified by a 7-day fluid intake record.
- …have a day-to-day variation in fluid intake of ≤ 25%.
- …have a verified UOsm aligned with the following:
- IF habitual low TFI, i.e., TFI ≤ 1.5 L/day for women OR ≤ 1.6 L/day for men have a UOsm ≥ 500 mOsm/kg.
- IF habitual high TFI, i.e., TFI ≥ 2.5 L/day for women OR ≥ 2.9 L/day for men have a UOsm < 500 mOsm/kg.
- …have a day-to-day variation in UOsm ≤ 28%; UOsm screening will be determined during verification and intervention periods.
- …have access to a domestic fridge at home so that urine samples can be stored prior to laboratory visits.
- …have a body mass index (BMI) < 30 kg/m².
- …have an IOS or Android smart phone and therefore the ability to download the HidrateSpark mobile application.
Exclusion Criteria:
Individuals who…
- …are vulnerable, as defined by individuals whose willingness to volunteer in the study may be unduly influenced by the expectation, whether justified or not, of benefits associated with participation, or of a retaliatory response from senior members of a hierarchy in case of refusal to participate (for example, if members of a group with a hierarchical structure linked to the investigator or to the sponsor, subordinate laboratory personnel, and employees of the investigator or sponsor.
- …are not able to answer questionnaires by writing whatever the reason.
- …have a loss of personal liberty, by administrative or judicial decision.
- …engage in > 5 hours of vigorous exercise a week.
- …engage in endurance exercise bouts lasting longer than 40 minutes.
- …do not have access to a domestic fridge at home so that urine samples can be stored prior to laboratory visits.
- …do not have an IOS or Android smart phone and therefore do not have the ability to download the HidrateSpark application.
- …are currently participating in another relevant clinical study (e.g., likely to influence hydration status or stress responsivity).
- …have completed the TSST before.
- …are expected to be living in the same home as a current participant.
Health screening
Individuals who…
- …have had any surgery or medical procedure requiring a general anaesthesia in the preceding 4 weeks, or who plan to have one during the study.
- …have an ongoing clinically diagnosed medical condition.
- …are currently taking prescribed medication for an ongoing medical condition.
- …are clinically diagnosed with one of the following psychiatric disorders known to influence stress reactivity: melancholic or atypical depression; panic disorder; obsessive-compulsive disorder; schizophrenia; social or generalised anxiety disorder; autism spectrum disorder; post-traumatic stress disorder; psychosis.
- …have a clinically diagnosed sleeping disorder.
- …are a current smoker (including e-cigarettes and vapes).
- …have had a respiratory or gastrointestinal infection within the last 2 weeks.
- …have a clinically diagnosed eating disorder.
- …have a special medicated diet (e.g., for obesity, anorexia, metabolic pathology).
- …have changed their dietary habits within the last 4 weeks or plan to change their diet during the study (e.g., start of a high-fibre diet, intentionally reducing or increasing calorie intake).
- …take dietary supplements known to influence stress reactivity (e.g., high-dose caffeine).
- …are women not currently on COC (e.g., naturally menstruating, or on progestogen-only forms of contraception, such as IUS, mini-pill, implant or injection).
- …are women currently using COC but for < 3 months prior to reading the participant information sheet or not planning to continue taking COC during their potential participation in the study.
- …are pregnant women or women planning to become pregnant during the study or are breast-feeding women.
Total fluid intake screening
Individuals who…
- …have a daily total fluid intake of:
- Men: between 1.6 and 2.9 L/day.
- Women: between 1.5 and 2.5 L/day.
- …have a day-to-day variation in fluid intake of >25%.
- …have a UOsm of:
- Men: < 500 mOsm/kg if habitual TFI is ≤ 1.6 L.day or ≥ 500 mOsm/kg if habitual TFI is ≥ 2.9 L/day.
- Women: < 500 mOsm/kg if habitual TFI is ≤ 1.5 L/day or ≥ 500 mOsm/kg if habitual TFI is ≥ 2.5 L/day.
- …have a day-to-day variation in UOsm > 28%.
- …habitually consume > 1.3 L/day of caffeinated hot beverages (e.g., tea, coffee; 1.3 L equates to 4 average sized mugs) as estimated by a fluid intake record questionnaire.
- …consume ≥ 91 units of alcohol per month (equivalent to more than 3 pints of beer per day or more than 3 large glasses of red wine per day).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
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No Intervention: Verification period
7 consecutive days where participants will drink fluids as they do normally do.
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Experimental: Intervention period
7 consecutive days where the participants will be randomly assigned to either the habitual or intervention condition.
On day 8, participants will perform a psychosocial stress test. Participants will be instructed to maintain their usual intake of other beverages i.e., tea/coffee to achieve their target total fluid intake. |
7-day intervention where the intake of drinking water will either be maintained at habitual level, increased (if habitually low) or decreased (if habitually high).
The TFI prescriptions during the intervention are derived from the mean TFI of habitually low and habitually high drinkers from a sex, age and country matched population.
Specifically, habitually low drinkers will be permitted a TFI of 3.5 L/day for men and 3.3 L/day for women and habitually high drinkers will be permitted a TFI of 1.3 L/day.
Participants will be instructed to maintain their usual intake of other beverages i.e., tea/coffee to achieve their target TFI.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Salivary cortisol reactivity to acute psychosocial stress
Time Frame: Assessed during the main trial (day 8 of the intervention period). Saliva samples will be taken pre (-30 and -5 minutes) and post (+0, +10, +20, +30, +45 and +60 minutes) stress test.
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Changes in the concentration of salivary free cortisol throughout the psychosocial stress test.
Cortisol will be measured in stimulated saliva samples and analysed by ELISA.
Delta changes (increase/decrease) in cortisol response will also be calculated.
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Assessed during the main trial (day 8 of the intervention period). Saliva samples will be taken pre (-30 and -5 minutes) and post (+0, +10, +20, +30, +45 and +60 minutes) stress test.
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Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Plasma copeptin
Time Frame: Copeptin will be assessed using a single blood sample taken on the morning of the main trial (day 8 of intervention period).
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Plasma copeptin will be analysed by ELISA and compared cross-sectionally between intervention conditions.
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Copeptin will be assessed using a single blood sample taken on the morning of the main trial (day 8 of intervention period).
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Urine osmolality (UOsm)
Time Frame: Late-afternoon urine samples will be collected on days 6 and 7 of the verification and intervention periods. Spot urine samples will be collected on the morning and afternoon visits of the main trial (day 8 of the intervention period).
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The concentration of osmotic solutes present in the urine, measured using a freezing point depression osmometer.
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Late-afternoon urine samples will be collected on days 6 and 7 of the verification and intervention periods. Spot urine samples will be collected on the morning and afternoon visits of the main trial (day 8 of the intervention period).
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Urine colour
Time Frame: Late-afternoon urine samples will be collected on days 6 and 7 of the verification and intervention periods. Spot urine samples will be collected on the morning and afternoon visits of the main trial (day 8 of the intervention period).
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Urine colour, a common marker used for assessing hydration status, will be assessed using a urine colour chart that has been developed to assess urine concentration in healthy humans.
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Late-afternoon urine samples will be collected on days 6 and 7 of the verification and intervention periods. Spot urine samples will be collected on the morning and afternoon visits of the main trial (day 8 of the intervention period).
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Plasma osmolality
Time Frame: A venous blood sample will be taken on the morning of the main trial (day 8 of the intervention period).
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A marker of intracellular osmolality, measured using a freezing point depression osmometer.
Plasma will be derived from venous blood.
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A venous blood sample will be taken on the morning of the main trial (day 8 of the intervention period).
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Sleep duration
Time Frame: Verification period: an actigraph will be worn continuously from day 5 until the end of the verification period. Intervention period: an actigraph will be worn continuously from day 5 until the stress test on day 8.
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Total sleep time (minutes) will be measured using accelerometery-based movement data recorded using a wrist-worn actigraph.
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Verification period: an actigraph will be worn continuously from day 5 until the end of the verification period. Intervention period: an actigraph will be worn continuously from day 5 until the stress test on day 8.
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Sleep efficiency
Time Frame: Verification period: an actigraph will be worn continuously from day 5 until the end of the verification period. Intervention period: an actigraph will be worn continuously from day 5 until the stress test on day 8.
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Sleep efficiency will be calculated using the following equation: (total sleep time/total time in bed) * 100.
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Verification period: an actigraph will be worn continuously from day 5 until the end of the verification period. Intervention period: an actigraph will be worn continuously from day 5 until the stress test on day 8.
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Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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State anxiety (STAI-S) response to acute psychosocial stress
Time Frame: Assed during the main trial (day 8 of the intervention period). The STAI-S will be administered pre (-30 and -5 minutes) and post (+0, +10, +20, +30, +45 and +60 minutes) stress test.
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State anxiety will be assessed throughout the acute stress test using the state aspect (form Y1) of the State-Trait Anxiety Inventory (STAI-S).
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Assed during the main trial (day 8 of the intervention period). The STAI-S will be administered pre (-30 and -5 minutes) and post (+0, +10, +20, +30, +45 and +60 minutes) stress test.
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Subjective stress response to acute psychosocial stress
Time Frame: Assessed during the main trial (day 8 of the intervention period). The Subjective Stress Scale will be administered pre (-30 and -5 minutes) and post (+0, +10, +20, +30, +45 and +60 minutes) post stress test.
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Subjective stress will be assessed using the Subjective Stress Scale, a 0-9 Likert scale where participants rate how stressed they feel right now (0 = no subjective stress experience, 4 = moderate subjective stress experience, 9 = extreme subjective stress experience).
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Assessed during the main trial (day 8 of the intervention period). The Subjective Stress Scale will be administered pre (-30 and -5 minutes) and post (+0, +10, +20, +30, +45 and +60 minutes) post stress test.
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Trait anxiety (STAI-T) profiling
Time Frame: The STAI-T will be administered once, immediately after enrolling.
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Trait anxiety will be measured using the trait aspect (form Y2) of the State-Trait Anxiety Inventory (STAI-T).
The STAI-T will be used as a part of participant profiling and demographic assessment.
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The STAI-T will be administered once, immediately after enrolling.
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Sleep quality (PSQI) profiling
Time Frame: The PSQI will be administered once, immediately after enrolling.
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The Pittsburgh Sleep Quality Index (PSQI) will be used to profile participants' sleep quality in the month prior to the study.
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The PSQI will be administered once, immediately after enrolling.
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Perceived stress (PSS) profiling
Time Frame: The PSS will be administered once, immediately after enrolling.
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The Perceived Stress Scale (PSS) will be used to profile participants' perceived stress in the month prior to the study.
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The PSS will be administered once, immediately after enrolling.
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Perceived stress during the verification and intervention periods
Time Frame: The PSS-week will be administered on the familiarisation visit (between verification and intervention periods) and the morning of the main trial (day 8 of the intervention period).
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A modified version of the PSS referring to the "last week" instead of "last month" (PSS-week) will be used to assess perceived stress during the verification and intervention periods.
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The PSS-week will be administered on the familiarisation visit (between verification and intervention periods) and the morning of the main trial (day 8 of the intervention period).
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Sleep quality during the verification and intervention periods
Time Frame: Up to 2 weeks. Assessed daily from day 1-7 of the verification period and day 1-7 of the intervention period.
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Participants will rate their sleep quality for the previous night on scale of 1 to 4. 1 = Very Poor, 2 = Poor, 3 = Good, 4 = Very good.
This question will be completed as part of a larger daily study diary.
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Up to 2 weeks. Assessed daily from day 1-7 of the verification period and day 1-7 of the intervention period.
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Mood during the verification and intervention periods
Time Frame: The BRUMS will be administered on the familiarisation visit (between verification and intervention periods) and morning of the main trial (day 8 of the intervention period).
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The Brunel Mood Scale (BRUMS) will be used to assess mood over the last week, and will be used to characterise mood during the verification and intervention periods.
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The BRUMS will be administered on the familiarisation visit (between verification and intervention periods) and morning of the main trial (day 8 of the intervention period).
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Nocturia during the verification and intervention periods
Time Frame: Up to 2 weeks. Assessed daily from day 1-7 of the verification period and day 1-7 of the intervention period.
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The number of night time voids will be self-reported, followed by a question assessing how much this bothered the participant on a scale of 1 (Not at all) to 10 (A great deal).
These will be completed as part of a larger daily study diary.
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Up to 2 weeks. Assessed daily from day 1-7 of the verification period and day 1-7 of the intervention period.
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Heart rate during acute psychosocial stress
Time Frame: Continuously measured during the stress test on the main trial (day 8 of the intervention period). Heart rate measurement will start at 30 minutes pre-stress test and continue until 60 minutes post-stress test.
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Heart rate will be measured using a telemetric chest strap.
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Continuously measured during the stress test on the main trial (day 8 of the intervention period). Heart rate measurement will start at 30 minutes pre-stress test and continue until 60 minutes post-stress test.
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Thirst sensation during the verification and intervention periods
Time Frame: Every evening during days 1-7 of the verification and intervention periods.
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A subjective rating of thirst will be recorded on a scale from 0 (not thirsty at all) to 7 (very, very thirsty) and a visual analogue scale ranging from "not thirsty" to "very thirsty".
The ratings will be completed in the evening (approx.
30 min before bed) as part of a larger daily study diary.
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Every evening during days 1-7 of the verification and intervention periods.
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Daily total fluid intake (TFI) during the verification and intervention periods
Time Frame: Up to 15 days. Daily from day 1 to 7 of the verification period and day 1 to 8 of the intervention period.
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TFI will be recorded as part of a larger daily study diary.
For this study, TFI refers to all drinks consumed e.g., water, tea/coffee, milk, juice, soft drinks and alcohol.
Each drink will be recorded as close to the time of consumption as possible.
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Up to 15 days. Daily from day 1 to 7 of the verification period and day 1 to 8 of the intervention period.
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Skin issue profiling
Time Frame: The SkinCARE Questionnaire will be administered once, during the familiarisation visit (between verification and intervention periods).
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The SkinCARE Questionnaire will be used to profile participants for self-reported skin issues experienced in the previous 4 weeks.
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The SkinCARE Questionnaire will be administered once, during the familiarisation visit (between verification and intervention periods).
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Physical activity
Time Frame: Verification period: an actigraph will be worn continuously from day 5 until the end of the verification period. Intervention period: an actigraph will be worn continuously from day 5 until the stress test on day 8
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Actigraphy data analysed to estimate physical activity
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Verification period: an actigraph will be worn continuously from day 5 until the end of the verification period. Intervention period: an actigraph will be worn continuously from day 5 until the stress test on day 8
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Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Neil P Walsh, PhD, Liverpool John Moores University
Publications and helpful links
General Publications
- Roussel R, Fezeu L, Bouby N, Balkau B, Lantieri O, Alhenc-Gelas F, Marre M, Bankir L; D.E.S.I.R. Study Group. Low water intake and risk for new-onset hyperglycemia. Diabetes Care. 2011 Dec;34(12):2551-4. doi: 10.2337/dc11-0652. Epub 2011 Oct 12.
- Dhabhar FS. Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res. 2014 May;58(2-3):193-210. doi: 10.1007/s12026-014-8517-0.
- Lazzarino AI, Hamer M, Gaze D, Collinson P, Steptoe A. The association between cortisol response to mental stress and high-sensitivity cardiac troponin T plasma concentration in healthy adults. J Am Coll Cardiol. 2013 Oct 29;62(18):1694-1701. doi: 10.1016/j.jacc.2013.05.070. Epub 2013 Jun 27.
- Turner AI, Smyth N, Hall SJ, Torres SJ, Hussein M, Jayasinghe SU, Ball K, Clow AJ. Psychological stress reactivity and future health and disease outcomes: A systematic review of prospective evidence. Psychoneuroendocrinology. 2020 Apr;114:104599. doi: 10.1016/j.psyneuen.2020.104599. Epub 2020 Feb 1.
- Gibbs DM. Vasopressin and oxytocin: hypothalamic modulators of the stress response: a review. Psychoneuroendocrinology. 1986;11(2):131-9. doi: 10.1016/0306-4530(86)90048-x.
- Roussel R, El Boustany R, Bouby N, Potier L, Fumeron F, Mohammedi K, Balkau B, Tichet J, Bankir L, Marre M, Velho G. Plasma Copeptin, AVP Gene Variants, and Incidence of Type 2 Diabetes in a Cohort From the Community. J Clin Endocrinol Metab. 2016 Jun;101(6):2432-9. doi: 10.1210/jc.2016-1113. Epub 2016 Apr 6.
- Enhorning S, Struck J, Wirfalt E, Hedblad B, Morgenthaler NG, Melander O. Plasma copeptin, a unifying factor behind the metabolic syndrome. J Clin Endocrinol Metab. 2011 Jul;96(7):E1065-72. doi: 10.1210/jc.2010-2981. Epub 2011 Apr 13.
- Boertien WE, Riphagen IJ, Drion I, Alkhalaf A, Bakker SJ, Groenier KH, Struck J, de Jong PE, Bilo HJ, Kleefstra N, Gansevoort RT. Copeptin, a surrogate marker for arginine vasopressin, is associated with declining glomerular filtration in patients with diabetes mellitus (ZODIAC-33). Diabetologia. 2013 Aug;56(8):1680-8. doi: 10.1007/s00125-013-2922-0. Epub 2013 Apr 28.
- Chan J, Knutsen SF, Blix GG, Lee JW, Fraser GE. Water, other fluids, and fatal coronary heart disease: the Adventist Health Study. Am J Epidemiol. 2002 May 1;155(9):827-33. doi: 10.1093/aje/155.9.827.
- Allen MD, Springer DA, Burg MB, Boehm M, Dmitrieva NI. Suboptimal hydration remodels metabolism, promotes degenerative diseases, and shortens life. JCI Insight. 2019 Sep 5;4(17):e130949. doi: 10.1172/jci.insight.130949.
- Sontrop JM, Dixon SN, Garg AX, Buendia-Jimenez I, Dohein O, Huang SH, Clark WF. Association between water intake, chronic kidney disease, and cardiovascular disease: a cross-sectional analysis of NHANES data. Am J Nephrol. 2013;37(5):434-42. doi: 10.1159/000350377. Epub 2013 Apr 17.
- Clark WF, Sontrop JM, Macnab JJ, Suri RS, Moist L, Salvadori M, Garg AX. Urine volume and change in estimated GFR in a community-based cohort study. Clin J Am Soc Nephrol. 2011 Nov;6(11):2634-41. doi: 10.2215/CJN.01990211. Epub 2011 Sep 1.
- Ferreira-Pego C, Guelinckx I, Moreno LA, Kavouras SA, Gandy J, Martinez H, Bardosono S, Abdollahi M, Nasseri E, Jarosz A, Babio N, Salas-Salvado J. Total fluid intake and its determinants: cross-sectional surveys among adults in 13 countries worldwide. Eur J Nutr. 2015 Jun;54 Suppl 2(Suppl 2):35-43. doi: 10.1007/s00394-015-0943-9. Epub 2015 Jun 12.
- Kashi DS, Hunter M, Edwards JP, Zemdegs J, Lourenco J, Mille AC, Perrier ET, Dolci A, Walsh NP. Habitual fluid intake and hydration status influence cortisol reactivity to acute psychosocial stress. J Appl Physiol (1985). 2025 Sep 1;139(3):698-708. doi: 10.1152/japplphysiol.00408.2025. Epub 2025 Aug 13.
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
Other Study ID Numbers
- Everyday Hydration Study 1
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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