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Item Effects of hypohydration and menstrual phase on pain : a thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy, School of Sport, Exercise and Nutrition, Massey University, Palmerston North, New Zealand(Massey University, 2021) Tan, Beverly Wei LinChronic pain is a pervasive health problem and is associated with tremendous societal and economic costs. However, current pain treatments are often ineffective because there are multiple factors that contribute to a person’s experience of pain. Recent research showed that mild hypohydration increases experimental pain sensitivity in men, but whether this also occurs in women has not been examined. The fluctuations in ovarian hormone (i.e., 17ß-oestradiol and progesterone) concentrations throughout the menstrual cycle may influence a woman’s pain sensitivity, as well as hydration levels. Therefore, interactions between hypohydration and the menstrual phase on pain may exist. To test this hypothesis, this thesis investigated the effects of hypohydration (induced by 24 hr of fluid restriction) on ischaemic pain sensitivity in 14 healthy, eumenorrheic women during the early follicular and mid-luteal phases of their menstrual cycle. In addition, the potential efficacy of acute water ingestion as a countermeasure to the negative impact of hypohydration on pain was also examined. Blood and urinary markers of hydration status indicated that 24 hr of fluid restriction successfully induced mild hypohydration. The major finding is that mild hypohydration reduced ischaemic pain tolerance (by 34 ± 46 s; P = .02, ηp 2 = .37) and increased subjective ratings of both pain intensity (by 0.7 ± 0.7 cm; P = .004; ηp 2 = .55) and pain unpleasantness (0.7 ± 0.9 cm; P = .02; ηp 2 = .40), irrespective of menstrual phase. Menstrual phase had no apparent effect on pain sensitivity or on hydration status. Acute water ingestion decreased thirst sensation (by 2.3 ± 0.9 cm; P < .001, ηp 2 = .88) but did not reverse the hyperalgesic effects of hypohydration. The effects of hypohydration on pain sensitivity were not explained by differences in state anxiety levels or mood state. In conclusion, the findings from this thesis extend to women, previous data in men that showed increases in pain sensitivity with mild hypohydration. This thesis also provides strong evidence that the menstrual phase does not influence pain sensitivity, after hydration status was controlled, the influence of potential confounders was minimised, and when menstrual phases were accurately verified. Lastly, these findings underscore the importance of ingesting fluids regularly throughout the day to maintain adequate hydration and avoid dehydration, especially for individuals experiencing pain.Item Hydration status in older adult patients and the relationship to factors affecting the access and intake of fluid : a thesis presented in partial fulfillment of the requirements for the degree of Masters of Science in Nutrition and Dietetics at Massey University(Massey University, 2019) Smithers, AlexandraObjectives: To assess fluid intake and access among hospitalised patients ≥65 or ≥55 years and to compare total fluid intake with the patient’s hydration status as determined by serum osmolality. Methods: Eligible patients, aged were recruited from Northshore and Waitakere hospitals within the Waitemata DHB in NZ. Socio-‐demographic characteristics were collected using an electronic questionnaire. The patients’ fluid intake was measured using the interactive FIAT, which enabled patients to select any beverage or high fluid food (e.g. jelly, custard, soup) that they had consumed from the hospital, onsite cafeteria, and vending machines. The patients were able to indicate how much they had consumed using a visual representation of the product filled at various volumes for guidance. The patients’ access to fluid and potential barriers to them meeting their fluid requirements was assessed using the FAST on an electronic device. Serum osmolality, sodium, potassium, haematocrit and creatinine were determined as indicators of hydration status and collected within 24 hours of the FIAT and FAST. Results: The study sample (n=54) included 23 (43%) men and 31 (57% women) with a mean age of 82.5±8.10 years. The FIAT identified that the majority of patients did not meet their fluid recommendations (n=46, 90%) and that half (n=27) had a low fluid intake of less than 1.6L/day. The FAST identified that of those patients with low fluid intake 16 (59%) struggled to open fluid containers and 10 (37%) sought assistance with opening. Patients who struggled to open fluids had a higher mean serum osmolality than those who didn’t struggle (297±6.88mOsm/kg versus 291±7.80mOsm/kg, P=0.009). Half of the patients were impending dehydration (n=15, 33%) or were dehydrated (n=9, 20%). Conclusions: Low fluid intake appeared to contribute to dehydration. Early assessment of fluid intake and hydration status is critical to prevent dehydration in older hospitalised patients. It is recommended that health care staff ensure all patients are able to open the provided fluids. Adequate hydration status may aid in the patients recovery, reducing their length of stay and thus the cost of their treatment.