Fluid Intake Habits Research Articles

The association between hydration state and the metabolism of phospholipids and amino acids among young adults: a metabolomic analysis

BackgroundWater is vital for humans' survival and general health, which is involved in various metabolic activities. ObjectivesThe aim of this study was to investigate the variation in urine metabolome and associated metabolic pathways among people with different hydration states. MethodsA metabolomic analysis was conducted using 24-h urine samples collected during a cross-sectional study on fluid intake behavior from December 9 to 11, 2021, in Hebei, China. Subjects were divided into the optimal hydration (OH, ≤500 mOsm/kg, n = 21), middle hydration (500–800 mOsm/kg, n = 33), and hypohydration groups (HH, >800 mOsm/kg, n = 13) based on the 3-d average 24-h urine osmolality. Collected 24-h urine samples from 67 subjects (43 males and 34 females) were analyzed for urine metabolome using liquid chromatography-MS. ResultsThe untargeted metabolomic analysis yielded 1055 metabolites by peak intensities. Integrating the results of the orthogonal projections to latent structures discriminant analysis and fold change test, 115 differential metabolites between the OH and HH groups, including phospholipids (PLs) and lysophospholipids, were identified. Among the 115 metabolites identified as differential metabolites, 85 were recorded by the Human Metabolome Database and uploaded to the Kyoto Encyclopedia of Genes and Genomes databases for pathway analysis. Twenty-one metabolic pathways were recognized. Phenylalanine metabolism (0.50, P = 0.007), phenylalanine, tyrosine, and tryptophan biosynthesis (0.50, P = 0.051), glycerophospholipid metabolism (0.31, P < 0.001), sphingolipid metabolism (0.27, P = 0.029), and cysteine and methionine metabolism (0.10, P = 0.066) had the leading pathway impacts. ConclusionsWe found variations in the urinary PLs and amino acids among subjects with different hydration states. Pathways associated with these differential metabolites could further impact various physiologic and pathologic functions. A more comprehensive and in-depth investigation of the physiologic and pathologic impact of the hydration state and the underlying mechanisms to elucidate and advocate optimal fluid intake habits is needed.This trial was registered at Chinese Clinical Trial Registry as ChiCTR2100045268.

Climate change and fluid status in children: early education as one response to an emerging public health problem.

As global warming intensifies, residents of temperate regions will also face heat waves in the near future. Food habits are one component in addressing the global challenge of climate change. However, water, the most important food for humans, has not been adequately addressed. For this commentary, on the one hand, publications on the increasing heat stress of children were consulted. On the other hand, publications on the special demands of children's temperature regulation in hot environments on fluid balance were analysed. The situation of young children in care facilities on days with heat stress is presented as a scenario. In this way, the effects of climatic changes on fluid balance can be estimated and measures to reduce heat stress and stabilise the fluid balance of children can be developed. For this analysis, first, infants will be considered in order to identify their specific fluid needs. Second, the possibilities for caregivers to improve fluid intake and train appropriate drinking habits already in infancy will be highlighted. Climate change should be included in recommendations on hydration for children. The need to adapt drinking habits requires educational approaches to weather and water - starting in early childhood care. In the face of rapid climate change, countries must act now by protecting, preparing and prioritising the high-risk group of children. Particular focus should be placed on supporting adequate hydration.

Extra-axial endoscopic third ventriculostomy: preliminary experience with a technique to circumvent conventional endoscopic third ventriculostomy complications.

Endoscopic third ventriculostomy (ETV) is mostly safe but may have serious complications. Most of the complications are inherent to the procedure's intra-axial nature. This study aimed to explore an alternative route to overcome inherent issues with conventional ETV. The authors performed supraorbital, subfrontal extra-axial ETV (EAETV) via the lamina terminalis. This prospective study began in October 2021 and included patients with obstructive triventricular hydrocephalus with a Glasgow Coma Scale score of 8 or more and a minimum follow-up of 3 months. Patients with multiloculated hydrocephalus and those younger than 1 year of age were excluded. The preoperative parameters etiology, symptoms, Evans' Index, frontal occipital horn ratio (FOHR), and third ventricle index were recorded. The surgical procedure is described. Postoperative evaluation included clinical (modified Rankin Scale [mRS]) and radiological assessment with CT and cine phase-contrast MRI. Preoperative and postoperative parameters were compared statistically. Ten patients were included in this study. Six patients had acute hydrocephalus, and 4 had chronic hydrocephalus. After EAETV, all patients showed clinical improvement. An mRS score of 0 or 1 was achieved in 9 patients, but the mRS score remained at 4 in a patient with tectal tuberculoma. There was a significant reduction in Evans' Index, FOHR, and third ventricle index after EAETV (p < 0.05). The mean percent reduction in Evans' Index was 20.80% ± 13.89%, the mean percent reduction in FOHR was 20.79% ± 12.98%, and the mean percent reduction in the third ventricle index was 37.45% ± 14.74%. CSF flow voids were seen in all cases. The results of CSF flow quantification parameters were as follows: mean peak velocity 3.82 ± 0.93 cm/sec, mean average velocity 0.10 ± 0.05 cm/sec, mean average flow rate 46.60 ± 28.58 μL/sec, mean forward volume 39.90 ± 23.29 μL, mean reverse volume 34.10 ± 15.98 μL, mean overall flow amplitude 74.00 ± 27.61 μL, and mean stroke volume 37.00 ± 13.80 μL. One patient developed a minor frontal lobe contusion. The frontal air sinus was breached in 5 patients, but none had CSF rhinorrhea. Transient supraorbital hypesthesia was seen in 3 patients. No patient had electrolyte disturbance or change in thirst or fluid intake habits. EAETV is a feasible, safe, and effective surgical alternative to conventional ETV.

ASSESSMENT OF FLUID INTAKE IN UROLITHIASIS PATIENTS ATTENDING UROLOGY CLINIC AT A TERTIARY CARE CENTERIN NORTH KARNATAKA

Urolithiasis is a highly prevalent disease all over the world. The prevalence of kidney stone disease in India is around 12%. Fluid intake is one of the important modifiable risk factors in kidney stone disease which can be considered for preventive measures. Nevertheless, various kinds of fluids cannot have the same effect on stone formation. North Karnataka region is more prone to stone formation due to a lack of fluid intake in several parts. We aim to assess the intake of various fluids and beverages along with water in urolithiasis patients attending the urology clinic at the tertiary care centre. A total of 240 kidney stone patients attending a urology clinic at a tertiary care centre were enrolled for the study between the period of 2020 to 2021. Structured and validated questionnaires comprising detailed information about brief medical history, lifestyle habits and fluid intake habits were provided to the subjects. Kidney stones were collected from all 240 patients to analyse the chemical composition and spectral studies. Out of 240 patients, 152 were male patients and 88 were females. The overall male-to-female ratio was 1.72: 1. The mean Body Mass Index (BMI) of all the patients was 25.83. The highest numbers of cases (43.3%) were seen in the age group above 50. Around 65.8% of cases used to consume less than an adequate amount of water. In stone analysis, 58.3% were calcium oxalates and 16.6% were uric acid stones which was the second-highest among cases. Fluids like milk, tea, and fruit juices are shown to reduce the risk of stone formation to some extent whereas less water intake was a major risk factor. Alcohol and aerated beverages are still having controversial results in stone formation. So, more studies have to be conducted in different geographic regions which may help to prevent the reoccurrence and may reduce the burden of urolithiasis.

THE EFFECTS OF FLUID INTAKE HABITS OF THE HEALTHY YOUNG POPULATION ON URINARY SYMPTOMS

Aim: The aim of this study is to evaluate of fluid intake habits and urinary symptoms in young, healthy population. Method: This study design was descriptive, cross-sectional type. A questionnaire was used to assess the fluid intake habits and The Urinary Symptom Profile (USP) (it is structure of 13 items in 3 dimensions: stress urinary incontinence, overactive bladder, and low stream). The study was completed by 602 university students. Results: The average daily fluid intake was &gt;2 L/day for both genders. The gender difference in fluid intake was significant (p &lt; 0.05). Male students were more than consumption of caffeinated drinks and alcohol. The urinary symptom profile score was stress urinary incontinence, overactive bladder and low stream 0.16, 2.41, 0.28 respectively. The male students compared to female students difference in stress urinary incontinence and low stream was found to be statistically significant (p &lt; 0.05). Conclusion: In conclusion, fluid intake habits and urinary symptoms differ between genders in the healthy young population.

Drinking Event Detection and Episode Identification Using 3D-Printed Smart Cup

Insufficient fluid intake is becoming an actual concern and problem of the elderly with dramatic increase of aging population. Poor fluid intake habits and Dehydration can cause long-term negative effects in mental and physical capabilities, and even death. Typical approaches to monitor individual fluid intake behavior and consumption of fluid quantities mainly rely on self-report, such as questionnaires. However, these typical approaches suffer issues in manual errors and cause additional burdens on the user. In recent years, advantages of wireless sensor networks and pervasive computing technologies have provided the opportunities to create automatic, objective and low-intrusive fluid intake monitoring systems. The aim of this work is to design a 3D-printed smart cup attached with a single accelerometer and drinking event detection algorithm that is feasible to spot fluid intake gestures, especially for detecting drinking events and recognizing complete periods of drinking. Such drinking information about timing and the frequency of fluid intake can reveal fluid intake habits and that is important for clinical assessment and intervention. The finding shows that the best system performance using k-nearest neighbors (k-NN) model with window size of 4s achieves 89.92% and 85.88% F-measure in event-defined and frame-defined evaluation approaches, respectively.

Fiber Intake, Fluid Intake and Defecation Habits of Pregnant Women in Indonesia

Fiber Intake, Fluid Intake and Defecation Habits of Pregnant Women in Indonesia

Dietary and fluid intake habits in nephrolithiasis patients presented to Ayub Teaching Hospital, Abbottabad

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nephrolithiasis is the 3rd most common clinical problem worldwide. The dietary and fluid intake factors play an important role in its causation. The present study was conducted to determine the dietary and fluid intake habits in patients presented with nephrolithiasis to Ayub Teaching Hospital, Abbottabad.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross-sectional study enrolled 140 patients by convenient sampling. The study was carried out at the Urology ward of Ayub Teaching Hospital, Abbottabad from June 2017 to June 2018. In this study, a self-maintained structured questionnaire was used to interview 140 patients admitted in both male and female urology ward of Ayub Teaching Hospital, Abbottabad. The questionnaire covered the fluid intake and dietary habits of patients with relevance to determinants such as the number of glasses per day, level of education, physical activity, the occupation of patients and source of drinking water. Data was collected through questionnaires and was analyzed using SPSS-23. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total of 140 patients were enrolled, 80 (57.1%) were males whereas 60 (42.9%) were females. Most of them, i.e. 116 (82.9%) were from rural areas, 132 (94.3%) belonged to poor socioeconomic status, 60 (42.9%) patients used the tap water for drinking and 80 (57.1%) had vegetables in their daily diet. Most 100 (71.4%) of them were illiterate, 92 (65.7%) working indoor and 60 (42.9%) drinking 5 to 10 glasses per day.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study highlights the poor dietary and fluid intake habits of patients presenting with nephrolithiasis.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Do bad habits bring a double constipation risk?

Good dietary habits, fluid intake, and regular exercise are considered to ease defecation although very few cases of chronic constipation can be managed through these approaches alone. Good defecation habits are recommended to avoid chronic constipation; however, the literature regarding this remains scarce. In this paper, we aimed to assess the association of bad habits concerning defecation, such as postponing, reluctance, or avoiding defecation anywhere but at home, with chronic constipation. This was a cross-sectional observational study including subjects from a tertiary hospital taskforce. In total, 415 of 910 eligible subjects were randomly selected. A cluster of questionnaires easy to understand and fill out was distributed. The questionnaires included queries regarding demographic data; past medical history; the presence of constipation; and dietary, other lifestyle, and defecation habits. The Rome III criteria for chronic constipation were also recorded. In total, 24.3% of the subjects considered themselves constipated, and 26.5% fulfilled the Rome III criteria for constipation. There were obvious differences in constipation prevalence by sex (men 5% vs. women 31%). Fiber-rich diet, fluid intake, and exercise habits were not related to constipation. Defecation habits significantly correlated with the presence or absence of constipation: regular schedule (OR 0.39; CI 95% 0.23-0.67), persistently postponing defecation (OR 1.94; CI 95% 1.13-3.34), or avoiding defecation anywhere but at home (OR 2.38; CI 95% 1.4-4.1). Compared with dietary habits, behavioral aspects surrounding defecation are more related to chronic constipation. Our results indicate that the modification of these bad habits may be the first step in chronic constipation treatment.

Fluid Intake Habits in Type 1 Diabetes Individuals during Typical Training Bouts

Background/Aims: Hyperglycemia may influence the hydration status in diabetic individuals. During exercise, type 1 diabetes mellitus (T1DM) individuals may be challenged by a higher risk of dehydration due to a combination of fluid losses from sweat and increased urine output via glycosuria. So far, no study has characterised spontaneous fluid intake in T1DM individuals during active trainings. Methods: A validated questionnaire was used to assess T1DM participants’ diabetes therapy, sports characteristics and fluid intake during training; results were then compared to an age- and sport-matched sample of non-diabetic individuals. Results: Ninety individuals completed the survey (n = 45 T1DM individuals, n = 45 matched controls). A proportion of T1DM ­individuals reported blood glucose levels greater than 10.0 mmol at both the start (28.9%) and end (24.4%) of the exercise. The mean self-reported fluid intake was greater in T1DM (0.60 ± 0.47 L·h^–1) compared to that of the control (0.37 ± 0.28 L·h^–1, p < 0.05). In spite of drinking fluid volumes in line with international guidelines, 84.4% of those with T1DM reported that they were still feeling thirsty at the end of their training session. Conclusions: T1DM individuals self-report spontaneously consuming fluid adequate volumes suggested by sport nutrition guidelines for non-diabetic athletes. Discrepancies in the T1DM subjectively reported feelings of thirst suggest that more education on hydration during exercise is needed for this population to adequately compensate for elevated blood glucose levels. It remains to be established whether fluid volumes suggested for healthy athletes are adequate for maintaining euhydration in T1DM patients due to their altered diuresis.

Hydration habits before, during and after training and competition days among amateur basketball players.

fluid intake before, during and after exercise is the most important way to replace water lost during exercise and avoid dehydration. to assess fluid intake habits before, during and after exercise in amateur basketball players on both training and competition days. one hundred and eighty-three amateur basketball players (87 women and 96 men, 19-29 years old) were interviewed. Data was obtained from a drinking habits questionnaire. overall, 20.8%, 5.5% and 2.7% of subjects did not drink before, during and after exercise on training days, respectively; 17.5% of subjects did not drink before exercise on competition days. Water was the preferred beverage before, during and after exercise on both training and competition days, with fruit juice being the second most consumed beverage before exercise. All subjects also drank fizzy drinks and other beverages during exercise on competition days. According to the recommendations, good hydration habits were found in 54.6%, 74.2% and 76.5% of subjects before, during and after training days, respectively. most amateur basketball players drink before, during and after exercise on both training and competition days, but not all of them complied with the hydration recommendations.

Psychological and Physical Environmental Factors in the Development of Incontinence in Adults and Children: A Comprehensive Review.

The aim of this review was to identify etiological environmental factors related to incontinence in children and adults. A variety of etiological environmental factors for the development of incontinence were identified. In children, these encompass stressful life events and trauma, family dysfunction, parental psychopathology, school-related stressors, toilet or "potty" training, fluid consumption habits, housing conditions, and the availability of toilets. In adults, physical exercise, obesity, working conditions, fluid intake, and the availability of toilets play a role. Intervening variables such as hormonal variations due to work shifts have also been identified as influencing the likelihood of incontinence. Current research suggests that environmental factors influence the development of incontinence in children and adults. The interactions between biological factors, the immediate environment, and intervening variables need to be explored in greater detail. Practical solutions to reduce barriers to adequate fluid intake and healthy toileting habits should be implemented in school and work settings.

How frequent is nocturia in medical students?

Objective. Nocturia is the most common lower urinary tract symptom and its prevalence increases with age. The frequency of nocturia and related bother are not widely investigated in young adults in the literature. In this study we aimed to investigate frequency, bothersome and relation of nocturia with anxiety in medical students. Methods. A questionnaire consisting of 19 items were sent to medical students via social media by using Survey Monkey TM software. Questions include demographic characteristics, fluid intake habits, voiding symptoms, and bother score related to nocturia. Also, Beck Anxiety Inventory was used to measure level of anxiety. Results. A total of 221 students replied the survey. The mean age was 20.7 ± 2.10. Forty-seven (21.3%) students had nocturia. The rate of nocturia was 27.4% and 13.4% in women and men, respectively ( p =0.011). The frequency of nocturia per night was 80.2%, 17.3% and 2.2% (1, 2, 3 times; respectively). While the frequency of nocturia was found to be related with bother scores there were no relation of gender with degree of bother. Conclusion. Nocturia is frequent in medical students, especially in women. Commonly, nocturia do not cause bother in young adults with one episode and it is not related with anxiety.

公共の水中運動施設における運動実施者の発汗および水分摂取の実態

公共の水中運動施設における運動実施者の発汗および水分摂取の実態

Fluid intake habits among school children in Madrid depend on the educational level of their parents.

Introduction: Several studies show the influence of educational level of parents in their children’s habits, including their fluid intake. Objective: To evaluate fluid intake by of school children of the Community of Madrid, differing according to educational level of their parents. Method: 564 schoolchildren (258 boys and 306 girls) aged 9-12 years, were studied. Data on fluid intake was obtained by applying a food intake record (3 days). Educational level of parents was self-declared, and it was classified depending on the type of studies completed (low, medium or high). Statistical data was obtained using SPSS (v 19.0) and it was set as statistical significance at p<0.05. Results: Children with mothers with higher educational level (medium or high) take more liquid (1,562.4±406.9 and 1,565.7±371.9 mL/day, respectively) than those whose mother′s educational level is lower (1395.04±367.5 mL/day) (p<0.001). It occurs similarly in the case of children whose fathers have higher educational level (fluid intake in children whose parents educated middle and upper: 1,538.7±411.4 and 1,606.8±380.5 mL/day, respectively), compared to those whose fathers have low educational level (1,404.7±350.7 mL/day) (p<0.001). Although in all cases fluid intake is below the adequate intakes (IOM, 2005). Conclusions: The water supply is below the appropriate in most of children studied. A lower educational level of parents is associated to lower fluid intake in their descendants, so these children need greater care in their patterns of hydration. Acknowledgements: This study was performed with financial help from the FISS (project number PI060318).

Parents body mass index as modulator of fluid intake habits among their children.

Introduction: Overweight and obesity is a growing health problem nowadays. Its relationship with inadequate life habits (including low fluid intake) is an added problem. Objective: To evaluate fluid intake by school children of the Community of Madrid according to body mass index (BMI) of their parents. Method: 564 schoolchildren (258 boys and 306 girls) aged 9-12 years, were studied. Data on fluid intake was obtained by applying a food intake record (3 days). BMI of children was calculated by measured weight and height. BMI of parents was calculated by weight and height self-reported by parents and it was classified according to WHO criteria (2000). Statistical data was obtained using SPSS (v 19.0). Results: 23.4% children had mothers with overweight/obesity (BMI ≥25 kg/m2). Fluid intake of these children was lower (1,465.52±390.3 mL/day) than those whose mother′s BMI below 25 kg/m2 (1,532.13±384.45 mL/day). BMI of children increased according to parents BMI, even more in the case of father BMI (r=0.243) vs mother BMI (r=0.199) (p<0.05). There were no differences in water intake of children considering BMI of fathers. Conclusions: Most of the studied children had an inadequate water intake. Higher BMI of mothers is linked with lower fluid intake in their descendants, and higher BMI of parents is associated to higher BMI in children. This group needs special counseling to improve their patterns of hydration. Acknowledgements: This study was performed with financial help from the FISS (project number PI060318).

Intake of water and beverages of children and adolescents in 13 countries.

PurposeTo describe the intake of water and all other beverages in children and adolescents in 13 countries of three continents. MethodsData of 3611 children (4–9 years) and 8109 adolescents (10–17 years) were retrieved from 13 cross-sectional surveys (47 % males). In three countries, stratified cluster sampling design was applied to randomly recruit schools classes. A quota method was applied in the other countries to randomly recruit participants. Details on the intake of all fluid types were obtained with a fluid-specific record over 7 consecutive days. ResultsIn the total sample, the highest mean intakes were observed for water (738 ± 567 mL/day), followed by milk (212 ± 209 mL/day), regular soft beverages (RSB) (168 ± 290 mL/day) and juices (128 ± 228 mL/day). Patterns characterized by a high contribution of water, RSB or hot beverages to total fluid intake were identified among the countries with close geographical location. Adolescents had a significantly lower milk intake and higher intake of RSB and hot beverages than children in most countries. The most consistent gender difference observed was that in both age groups males reported a significantly higher RSB consumption than females.ConclusionOn average, water was the fluid consumed in the largest volume by children and adolescents, but the intake of the different fluid types varied substantially between countries. Since the RSB intake was as large, or even larger, than water intake in some countries, undertaking actions to improve fluid intake habits of children and adolescents are warranted.Electronic supplementary materialThe online version of this article (doi:10.1007/s00394-015-0955-5) contains supplementary material, which is available to authorized users.

Habits of fluid and electrolytes intake in elite athletes

Introduction: Dehydration develops when the body fluid losses exceed fluid intake. It may occur during exercise, heat stress, restricted fluid intake, or any combination of these. Marginal dehydration (loss of &gt; 2% body weight) can compromise aerobic exercise performance, particularly in hot weather conditions, and may disturb fluid and electrolyte balance. The aim of the study was to determine the quantity, type and dynamic of fluid intake during athletic performance in endurance sports (football and basketball) in two age categories: juniors (under the age of 18) and seniors (over the age of 18).Methods: Research included 100 athletes playing in Premier League in Bosnia-Herzegovina. We formed groups by sport type (football and basketball) and age (&lt;18 and ≥18 years). Questionnaire with questions about the fluid intake habits was used for data collection. Results: There were 53 football players and 47 basketball players. All the participants were male. Average age of the participants was 19.3 ± 4.58. Habit of weighing before and after training was present in less than 44% of players among all the groups. Seniors were more frequently measuring their weight compared to junior players (p=0.01). Basketball players and players younger than 18 years were most frequently taking more than 2L of water per day. Most of the players, regardless of sport type or age group were not taking at least ½ L of isotonic fluid before the training. Signs of dehydration were more frequently observed in players under 18 years old, with most frequent sign being dry throat and sudden fatigue.Conclusion: Water and electrolytes intake before, during and after training of the athletes were inadequate regardless of type of sports and the age of athletes.

A Water Intervention Program to Improve Fluid Intakes Among French Women

This research aimed at assessing the impact of a water intervention program on fluid intake over a 12-month period in free-living conditions. A total of 178 French women with low fluid intake habits were enrolled in a short-term program from 4 weeks’ to 4 months’ duration including home deliveries of bottled water and educational content on water and health. Fluid intakes were assessed at baseline and at 2, 6, and 12 months. Results show a significant improvement in total fluid intake mainly from water intake over 12 months. An intervention program combining bottled water supply and educational information is efficient to increased sustainably water intake among low drinkers in free-living conditions.

Nutritional Intake and Gastrointestinal Problems during Competitive Endurance Events

There is little information about the actual nutrition and fluid intake habits and gastrointestinal (GI) symptoms of athletes during endurance events. This study aimed to quantify and characterize energy, nutrient, and fluid intakes during endurance competitions and investigate associations with GI symptoms. A total of 221 endurance athletes (male and female) were recruited from two Ironman triathlons (IM Hawaii and IM GER), a half-Ironman (IM 70.3), a MARATHON, a 100/150-km CYCLE race. Professional cyclists (PRO) were investigated during stage racing. A standardized postrace questionnaire quantified nutrient intake and assessed 12 GI symptoms on a scale from 0 (no problem) to 9 (worst it has ever been) in each competition. Mean CHO intake rates were not significantly different between IM Hawaii, IM GER, and IM 70.3 (62 ± 26, 71 ± 25, and 65 ± 25 g·h(-1), respectively), but lower mean CHO intake rates were reported during CYCLE (53 ± 22 g·h(-1), P = 0.044) and MARATHON (35 ± 26 g·h(-1), P < 0.01). Prevalence of serious GI symptoms was highest during the IM races (∼31%, P = 0.001) compared with IM 70.3 (14%), CYCLE (4%), MARATHON (4%), and PRO (7%) and correlated to a history of GI problems. In all data sets, scores for upper and lower GI symptoms correlated with a reported history of GI distress (r = 0.37 and r = 0.51, respectively, P < 0.001). Total CHO intake rates were positively correlated with nausea and flatulence but were negatively correlated with finishing time during both IM (r = -0.55 and r = -0.48, P < 0.001). The present study demonstrates that CHO intake rates vary greatly between events and individual athletes (6-136 g·h(-1)). High CHO intake during exercise was related not only to increased scores for nausea and flatulence but also to better performance during IM races.