Effect of Coconut Water on Hydration Status in Pediatric Population
Condition: Sports Nutrition
Study type: Interventional
Phase: Phase 4

Summary: 
      Introduction: The dehydration is a very common problem that is often not identified. The
      pediatric population is more susceptible to dehydration due to its physiological
      characteristics. Proper hydration is crucial for health since any degree of dehydration
      causes a reduction in physical and mental work capacity, hence the importance of preventing
      it by considering the type of drink. There are multiple beverage options, including
      industrial oral electrolytes (OE), on the other hand, coconut water (CW) has been studied as
      a natural alternative beverage with characteristics that can help maintain a state of
      euhydration. Objective: To determine if AC has a greater effect on hydration status than OE
      in adolescents who perform physical exercise. Material and methods: RCT, double blind. 34
      subjects aged 13.02 ± 1.08 years were selected, assigned to treatment with either OE
      (Electrolit®) or CW. They received a weekly physical exercise session (4 weeks). Hydration
      was personalized (ml x kilograms of weight) and hydration was evaluated by Urine Specific
      Gravity (USG), Total Body Water (TBW) by bioimpedance and changes in body mass. Results:
      There were no significant differences in hydration in the first 3 exercise sessions (p>0.05),
      however, in the last session there was a significant difference between treatments (p=0.003).
      Conclusion: AC and OE have the same effect on hydration levels in adolescents who perform
      physical exercise.
    

Detailed description: 
      1. For current epidemiological reasons of Covid-19, an increase of 30% of losses has been
           considered already established in the sample size, giving a total of 22 participants per
           group (44 in total). For the same reason, two groups of 22 participants (11 experimental
           and 11 controls) will be divided in order to reduce the population and the risk of
           contagion, following the health protocols established by the institution mentioned in
           Annex 2. The type of randomization to be used in the study will be based on the assigned
           treatment (A / B) by the balanced block method. This method consists of assembling a
           series of blocks, made up of a certain number of cells, in which the different types of
           treatment are included. The number of blocks will be determined by the number of
           participants to be included and the number of cells that it has been decided to include
           in each block, so in the present study 12 blocks with four treatment cells will be
           placed, giving a total of 44 treatments to the same as the number of study subjects.
           Each block will contain in each cell one of the treatment alternatives and within each
           block there must be a balanced number of possible treatments. Treatments A and B will be
           written in blocks (22 with treatment A and 22 with treatment B). The randomization will
           be carried out by a person external to the study and the same person will be the one who
           will randomly assign the treatments in the blocks and the numbering of each block. They
           will be summoned to 12:00 noon on Monday or Tuesday only according to the group assigned
           to start with the collection of personal data (Annex 3) and a mental test called
           Psychological Characteristics related to Sports Performance (CPRD) (Annex 4) which will
           be applied by an expert in the area of psychology, in addition, if training is required
           for the application of the test, the main researcher will be trained to be able to
           perform it properly.

        2. After taking personal data, hydrating drinks will be administered immediately before
           training (7 ml x kg of weight) 4 hours before. At 2:00 p.m., your corresponding
           hydrating drink (4 ml x kg of weight) will be administered again. Each participant will
           have a 600 ml graduated glass that will be granted by the researcher to keep track of
           the drink administered at the different times of each session.

        3. Immediately afterwards, the anthropometry and urine sample will be taken. To record body
           mass, the protocol developed by the International Society for the Advancement of
           Kinanthropometry (ISAK) will be followed. The study subjects will be weighed in sports
           shorts and barefoot before starting physical exercise, having been told that, in the
           case of urinating or defecating, they should do so before the initial weigh-in.
           Simultaneously with taking the body mass, the% ACT will be determined by electrical
           bioimpedance. To record body mass and% of ACT water, the Tanita BC-533 bioimpedance
           scale will be used with a reliability of 97%, precision of 0.1kg and with a measuring
           range of 0-150kg.

        4. Once the anthropometry and urine sample have been taken, a 200 ml dose will be
           administered immediately before exercise (10-15) min.

        5. They will continue with the physical exercise protocol which will receive a physical
           exercise session per week (Tuesdays), with a duration of 1 hour and 15 minutes each
           session. The exercise sessions will be carried out in the Domingo Savio sports fields
           and will be taught by the principal investigator who has worked as a sports coach in the
           soccer area for 3 years, in addition to being trained for this purpose in the same
           institution where he was will carry out the study. Days prior to the start of the
           practical execution of the protocol, parents and selected students will be summoned to a
           meeting in order to explain the dynamics that will take place. The physical exercise
           sessions will consist of 4 parts:

             1. The first part of the workout will consist of a 10 minute warm-up and stretching to
                increase your basal HR and prepare the body for the next high intensity stages and
                prevent injuries in teens. The warm-up will have a break of 5 minutes and hydration
                of 2 ml x kg of weight.

             2. This second part will take place in 12 min of continuous jogging around the field
                at an average pace, aiming to do one lap every 1 minute 36 seconds, giving a total
                of 7 and a half laps to the soccer field (Cooper's Test). 8 min rest for the total
                recovery of energy systems and hydration of 2 ml x kg of weight.

             3. In the second part of the training, the adolescents must run from one line to
                another, twenty meters apart, at the pace set by a tape. This race pace will
                increase every minute. Subjects start the test at a speed of 8 km / hr, the first
                minute increases to 9 km / hr and thereafter, each minute increases the pace ½ km /
                hr. The test ends when they cannot keep up with the pace set (Test de course
                Navette). Approximate time 10 min with 8 min rest and hydration of 2 ml x kg of
                weight.

             4. In this last part of the training session, it is a type of exercise based on
                tabatas, which consists of performing 8 different exercises for 20 seconds per 10
                seconds of rest to the rhythm of the marked music, giving a time of 4 minutes per
                tabata. .2 tabatas will be made with an intermediate rest of 3 min between each
                tabata and hydration of 2 ml x kg of weight.

        6. At the end of this last stage of the training session, anthropometry and information
           collection will be taken where the percentage of weight change, body composition with
           bioimpedance will be determined before starting the final hydration, since if it is done
           at the In reverse, it is very likely that no one will come out in a state of
           dehydration. After the anthropometry, they will be administered the corresponding
           post-exercise hydration (1.5 ml x kg of weight) and the urine sample will be collected.
           In the event that a subject has not urinated due to dehydration, their sterilized bottle
           will be taken home and the head of research will be notified immediately for its proper
           conservation or transport.

           The calculation of the percentage of lost weight will be calculated using the following
           formula:% Weight Loss or Dehydration = [(Initial Weight - Final Weight) / Initial
           Weight] x 100.

        7. As a final point, the data obtained before the exercise will be compared with the data
           obtained after the exercise, where the euhydration cut-off points will be analyzed to
           categorize the subject as dehydrated or euhydrated. An effective drink (CW or OE) will
           be considered when any 2 or more indicators (GEO, ACT or Body Mass) are consistent with
           the euhydration thresholds.
    

Intervention name(s): Coconut Water; Sport Drink
Intervention type(s): Device; Drug
Intervention description(s): Coconut water is the clear fluid inside the coconut, has natural electrolytes such as potassium, sodium and manganese.; A type to sport drink is isotonic drink. Is an industrialized drink that containing water, carbohydrates, and 4-8% electrolytes.
Other intervention name(s): Isotonic Drink
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two groups of subjects will be formed that will be randomized by the type of treatment they will receive, which will be the same during the 4 interventions of the study.
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: Dehydration; Pediatric population; Coconut water; Sport drink; Hydration status; Physical exercise