The effect of hypohydration on endothelial function in young healthy adults



Hypohydration has been suggested as a predisposing factor for several pathologies including cardiovascular diseases (CVD). While CVD are the leading cause of death worldwide, no study has investigated whether acute hypohydration affects endothelial function and cardiovascular function.


Ten young, healthy males participated in this crossover study (age: 24.3 ± 2.3 year; weight: 80.8 ± 5.3 kg; BMI: 24.3 ± 0.4 kg m−2). Each subject completed two measurements of endothelial function by flow-mediated dilation (FMD) in euhydrated and hypohydrated state separated by 24 h. Following baseline assessment of hydration status and FMD, the subjects completed 100 min of low-intensity intermittent walking exercise to achieve hypohydration of −2 % of individual body mass. For the rest of the day, a standardized, low water content diet was provided. The following morning, hydration markers and endothelial function were recorded.


Hypohydration by −1.9 ± 0.1 % of body mass resulted in decreased plasma volume by −3.5 ± 1.8 % and increased plasma osmolality by 9 ± 2 mmol kg−1 (P < 0.001). FMD as a response to hypohydration decreased by −26.8 ± 3.9 % (P < 0.05).


The data suggested that a small degree of hypohydration induced by moderate exercise and fluid restriction significantly impaired endothelial function.

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  1. 1.

    Chan J, Knutsen SF, Blix GG, Lee JW, Fraser GE (2002) Water, other fluids, and fatal coronary heart disease: the adventist health study. Am J Epidemiol 155:827–833

    Article  Google Scholar 

  2. 2.

    Roussel R, Fezeu L, Bouby N, Balkau B, Lantieri O, Alhenc-Gelas F, Marre M, Bankir L, Group DESIRS (2011) Low water intake and risk for new-onset hyperglycemia. Diabetes Care 34:2551–2554

    CAS  Article  Google Scholar 

  3. 3.

    Thornton SN (2009) Angiotensin, the hypovolaemia hormone, aggravates hypertension, obesity, diabetes and cancer. J Intern Med 265:616–617

    CAS  Article  Google Scholar 

  4. 4.

    Lang F, Ritz E, Voelkl J, Alesutan I (2013) Vascular calcification-is aldosterone a culprit? Nephrol Dial Transplant 28:1080–1084

    CAS  Article  Google Scholar 

  5. 5.

    Dmitrieva NI, Burg MB (2015) Elevated sodium and dehydration stimulate inflammatory signaling in endothelial cells and promote atherosclerosis. PLoS ONE 10:e0128870

    Article  Google Scholar 

  6. 6.

    Strippoli GF, Craig JC, Rochtchina E, Flood VM, Wang JJ, Mitchell P (2011) Fluid and nutrient intake and risk of chronic kidney disease. Nephrology (Carlton) 16:326–334

    Article  Google Scholar 

  7. 7.

    Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, McCullough PA, Kasiske BL, Kelepouris E, Klag MJ, Parfrey P, Pfeffer M, Raij L, Spinosa DJ, Wilson PW (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American heart association councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention. Circulation 108:2154–2169

    Article  Google Scholar 

  8. 8.

    Verma S, Anderson TJ (2002) Fundamentals of endothelial function for the clinical cardiologist. Circulation 105:546–549

    CAS  Article  Google Scholar 

  9. 9.

    Ross R (1999) Atherosclerosis is an inflammatory disease. Am Heart J 138:S419–S420

    CAS  Article  Google Scholar 

  10. 10.

    Yeboah J, Folsom AR, Burke GL, Johnson C, Polak JF, Post W, Lima JA, Crouse JR, Herrington DM (2009) Predictive value of brachial flow-mediated dilation for incident cardiovascular events in a population-based study: the multi-ethnic study of atherosclerosis. Circulation 120:502–509

    Article  Google Scholar 

  11. 11.

    Becker RC (1993) The role of blood viscosity in the development and progression of coronary artery disease. Cleve Clin J Med 60:353–358

    CAS  Article  Google Scholar 

  12. 12.

    Lee AJ, Mowbray PI, Lowe GD, Rumley A, Fowkes FG, Allan PL (1998) Blood viscosity and elevated carotid intima-media thickness in men and women: the Edinburgh artery study. Circulation 97:1467–1473

    CAS  Article  Google Scholar 

  13. 13.

    Tonstad S, Klemsdal TO, Landaas S, Hoieggen A (2006) No effect of increased water intake on blood viscosity and cardiovascular risk factors. Br J Nutr 96:993–996

    CAS  Article  Google Scholar 

  14. 14.

    Cohen RA (1995) The role of nitric oxide and other endothelium-derived vasoactive substances in vascular disease. Prog Cardiovasc Dis 38:105–128

    CAS  Article  Google Scholar 

  15. 15.

    Kavouras SA, Armstrong LE, Maresh CM, Casa DJ, Herrera-Soto JA, Scheett TP, Stoppani J, Mack GW, Kraemer WJ (2006) Rehydration with glycerol: endocrine, cardiovascular, and thermoregulatory responses during exercise in the heat. J Appl Physiol 100:442–450

    CAS  Article  Google Scholar 

  16. 16.

    Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS (2007) American college of sports medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc 39:377–390

    Article  Google Scholar 

  17. 17.

    Castellani JW, Maresh CM, Armstrong LE, Kenefick RW, Riebe D, Echegaray M, Casa D, Castracane VD (1997) Intravenous vs. oral rehydration: effects on subsequent exercise-heat stress. J Appl Physiol 82:799–806

    CAS  Google Scholar 

  18. 18.

    Kenefick RW, Maresh CM, Armstrong LE, Castellani JW, Riebe D, Echegaray ME, Kavorous SA (2000) Plasma vasopressin and aldosterone responses to oral and intravenous saline rehydration. J Appl Physiol 89:2117–2122

    CAS  Google Scholar 

  19. 19.

    Kollias GE, Stamatelopoulos KS, Papaioannou TG, Zakopoulos NA, Alevizaki M, Alexopoulos GP, Kontoyannis DA, Karga H, Koroboki E, Lekakis JP, Papamichael CM (2009) Diurnal variation of endothelial function and arterial stiffness in hypertension. J Hum Hypertens 23:597–604

    CAS  Article  Google Scholar 

  20. 20.

    Mitchell GF, Parise H, Vita JA, Larson MG, Warner E, Keaney JF Jr, Keyes MJ, Levy D, Vasan RS, Benjamin EJ (2004) Local shear stress and brachial artery flow-mediated dilation: the Framingham Heart Study. Hypertension 44:134–139

    CAS  Article  Google Scholar 

  21. 21.

    Boon JC, Westbroek DL, Stelter WJ, Messmer K (1978) Sodium nitroprusside-induced hypotension in dogs. Drug sensitivity and resistance experimentally provoked by circulating blood volume alterations. Eur Surg Res 10:382–388

    CAS  Article  Google Scholar 

  22. 22.

    Dill DB, Costill DL (1974) Calculation of percentage changes in volumes of blood, plasma, and red cells in dehydration. J Appl Physiol 37:247–248

    CAS  Google Scholar 

  23. 23.

    Green DJ, Maiorana A, O’Driscoll G, Taylor R (2004) Effect of exercise training on endothelium-derived nitric oxide function in humans. J Physiol 561:1–25

    CAS  Article  Google Scholar 

  24. 24.

    Greenleaf JE (1992) Problem: thirst, drinking behavior, and involuntary dehydration. Med Sci Sports Exerc 24:645–656

    CAS  Article  Google Scholar 

  25. 25.

    Robertson GL (1984) Abnormalities of thirst regulation. Kidney Int 25:460–469

    CAS  Article  Google Scholar 

  26. 26.

    Karatzi K, Papamichael C, Karatzis E, Papaioannou TG, Voidonikola PT, Lekakis J, Zampelas A (2007) Acute smoking induces endothelial dysfunction in healthy smokers. Is this reversible by red wine’s antioxidant constituents? J Am Coll Nutr 26:10–15

    Article  Google Scholar 

  27. 27.

    Fels J, Oberleithner H, Kusche-Vihrog K (2010) Ménage à trois: aldosterone, sodium and nitric oxide in vascular endothelium. Biochim Biophys Acta 1802:1193–1202

    CAS  Article  Google Scholar 

  28. 28.

    Thornton SN (2011) Angiotensin inhibition and longevity: a question of hydration. Pflugers Arch 461:317–324

    CAS  Article  Google Scholar 

  29. 29.

    Druppel V, Kusche-Vihrog K, Grossmann C, Gekle M, Kasprzak B, Brand E, Pavenstadt H, Oberleithner H, Kliche K (2013) Long-term application of the aldosterone antagonist spironolactone prevents stiff endothelial cell syndrome. FASEB J 27:3652–3659

    Article  Google Scholar 

  30. 30.

    Higashi Y, Noma K, Yoshizumi M, Kihara Y (2009) Endothelial function and oxidative stress in cardiovascular diseases. Circ J 73:411–418

    CAS  Article  Google Scholar 

  31. 31.

    King MA, Clanton TL, Laitano O (2016) Hyperthermia, dehydration, and osmotic stress: unconventional sources of exercise-induced reactive oxygen species. AJP 310:R105–R114

    Google Scholar 

  32. 32.

    Boegehold MA, Drenjancevic I, Lombard JH (2015) Salt, angiotensin II, superoxide, and endothelial function. Compr Physiol 6:215–254

    Article  Google Scholar 

  33. 33.

    Gonzalez-Alonso J, Mora-Rodriguez R, Below PR, Coyle EF (1997) Dehydration markedly impairs cardiovascular function in hyperthermic endurance athletes during exercise. J Appl Physiol 82:1229–1236

    CAS  Google Scholar 

  34. 34.

    Ma TK, Kam KK, Yan BP, Lam YY (2010) Renin-angiotensin-aldosterone system blockade for cardiovascular diseases: current status. Br J Pharmacol 160:1273–1292

    CAS  Article  Google Scholar 

  35. 35.

    Thornton SN, Hess K (2009) Exercise generates lactate and fluid intake: effects on mitochondrial function in heart and vascular smooth muscle. Hypertension 54:e14; author reply e15–e16

  36. 36.

    Koenig W, Sund M, Filipiak B, Doring A, Lowel H, Ernst E (1998) Plasma viscosity and the risk of coronary heart disease: results from the MONICA-Augsburg Cohort Study, 1984 to 1992. Arterioscler Thromb Vasc Biol 18:768–772

    CAS  Article  Google Scholar 

  37. 37.

    Lowe GD, Lee AJ, Rumley A, Price JF, Fowkes FG (1997) Blood viscosity and risk of cardiovascular events: the Edinburgh artery study. Br J Haematol 96:168–173

    CAS  Article  Google Scholar 

  38. 38.

    Ritz P, Berrut G (2005) The importance of good hydration for day-to-day health. Nutr Rev 63:S6–S13

    Article  Google Scholar 

  39. 39.

    Manz F, Wentz A (2005) The importance of good hydration for the prevention of chronic diseases. Nutr Rev 63:S2–S5

    Article  Google Scholar 

  40. 40.

    Haveman-Nies A, de Groot LC, Van Staveren WA (1997) Fluid intake of elderly Europeans. J Nutr Health Aging 1:151–155

    CAS  Google Scholar 

  41. 41.

    Stachenfeld NS, DiPietro L, Nadel ER, Mack GW (1997) Mechanism of attenuated thirst in aging: role of central volume receptors. Am J Physiol 272:R148–R157

    CAS  Google Scholar 

  42. 42.

    Stookey JD (2005) High prevalence of plasma hypertonicity among community-dwelling older adults: results from NHANES III. J Am Diet Assoc 105:1231–1239

    Article  Google Scholar 

  43. 43.

    Padilla J, Johnson BD, Newcomer SC, Wilhite DP, Mickleborough TD, Fly AD, Mather KJ, Wallace JP (2008) Normalization of flow-mediated dilation to shear stress area under the curve eliminates the impact of variable hyperemic stimulus. Cardiovasc Ultrasound 6:44

    Article  Google Scholar 

  44. 44.

    Brockow T, Conradi E, Ebenbichler G, Michalsen A, Resch KL (2011) The role of mild systemic heat and physical activity on endothelial function in patients with increased cardiovascular risk: results from a systematic review. Forschende Komplementarmedizin 18:24–30

    Article  Google Scholar 

  45. 45.

    Rognmo O, Bjornstad TH, Kahrs C, Tjonna AE, Bye A, Haram PM, Stolen T, Slordahl SA, Wisloff U (2008) Endothelial function in highly endurance-trained men: effects of acute exercise. J Strength Cond Res 22:535–542

    Article  Google Scholar 

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The authors would like to thank the laboratory staff at Alexandra Hospital for their assistance. We gratefully also thank Dr. Evan C. Johnson & Lisa T. Jansen for their contribution to the manuscript.

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Correspondence to Stavros A. Kavouras.

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SAK has active grants with Danone Research.

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Arnaoutis, G., Kavouras, S.A., Stratakis, N. et al. The effect of hypohydration on endothelial function in young healthy adults. Eur J Nutr 56, 1211–1217 (2017).

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  • Dehydration
  • Endothelial
  • Flow-mediated dilation
  • Fluid balance
  • Cardiovascular disease