Fatigue and fluid hydration status in multiple sclerosis: A hypothesis

Abstract

Background:

Fatigue is a prevalent and functionally disabling symptom for individuals living with multiple sclerosis (MS) which is poorly understood and multifactorial in etiology. Bladder dysfunction is another common MS symptom which limits social engagement and quality of life. To manage bladder issues, individuals with MS tend to limit their fluid intake, which may contribute to a low-hydration (LoH) state and fatigue.

Objective:

To evaluate the relationship between patient-reported MS fatigue, bladder dysfunction, and hydration status.

Methods:

We performed a prospective cross-sectional study in 50 women with MS. Participants submitted a random urine sample and completed several fatigue-related surveys. Using a urine specific gravity (USG) threshold of 1.015, we classified MS subjects into two groups: high-hydration (HiH) and LoH states.

Results:

LoH status was more common in MS subjects with bladder dysfunction. Statistically significant differences in self-reported Fatigue Performance Scale were observed between HiH and LoH subjects (p = 0.022). USG was significantly correlated with fatigue as measured by the MS Fatigue Severity Scale (FSS) score (r = 0.328, p = 0.020).

Conclusion:

Hydration status correlates with self-reported fatigue, with lower fatigue scores found in those with HiH status (USG < 1.015).

Keywords

Multiple sclerosis fatigue dehydration lifestyle bladder control scale modified fatigue impact scale fatigue severity scale

Get full access to this article

View all access options for this article.

References

Krupp

. Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease. Mult Scler 2006; 12(4): 367–368.

Induruwa

Constantinescu

Gran

. Fatigue in multiple sclerosis—A brief review. J Neurol Sci 2012; 323(1–2): 9–15.

Lerdal

Celius

Krupp

. A prospective study of patterns of fatigue in multiple sclerosis. Eur J Neurol 2007; 14(12): 1338–1348.

Krupp

Alvarez

LaRocca

. Fatigue in multiple sclerosis. Arch Neurol 1988; 45: 435–437.

Mills

Young

. A medical definition of fatigue in multiple sclerosis. Q J Med 2007; 101: 49–60.

Williams

. Management of bladder dysfunction in patients with multiple sclerosis. Nurs Stand 2012; 13(23): 39–46.

Armstrong

Ganio

Casa

. Mild dehydration affects mood in healthy young women. J Nutr 2012; 142(2): 382–388.

Armstrong

. Assessing hydration status: The elusive gold standard. J Am Coll Nutr 2007; 26(5 Suppl.): 575S–584S.

Baron

Courbebaisse

Lepicard

. Assessment of hydration status in a large population. Br J Nutr 2015; 113(1): 147–158.

10.

Perrier

Vergne

Klein

. Hydration biomarkers in free-living adults with different levels of habitual fluid consumption. Br J Nutr 2013; 109(9): 1678–1687.

11.

Malisova

Athanasatou

Pepa

. Water intake and hydration indices in healthy European adults: The European Hydration Research Study (EHRS). Nutrients 2016; 8(4): 204.

12.

Armstrong

Maresh

Castellani

. Urinary indices of hydration status. Int J Sport Nutr 1994; 4(3): 265–279.

13.

Oppliger

Magnes

Popowski

. Accuracy of urine specific gravity and osmolality as indicators of hydration status. Int J Sport Nutr Exe 2005; 15(3): 236–251.

14.

Armstrong

Johnson

Munoz

. Hydration biomarkers and dietary fluid consumption of women. J Acad Nutr Diet 2012; 112(7): 1056–1061.

15.

Hohol

Orav

Weiner

. Disease steps in multiple sclerosis: A simple approach to evaluate disease progression. Neurology 1995; 45: 251–255.

16.

Marrie

Goldman

. Validity of performance scales for disability assessment in multiple sclerosis. Mult Scler 2007; 13: 1176–1182.

17.

Turnbull

Hoare

Ritvo

. The assessment of bowel and bladder dysfunction in clinic attending MS patients. Presented at department of medicine research symposium. Dalhousie University, Halifax, NS, Canada, May 1993.

18.

Krupp

LaRocca

Meir-Nash

. The fatigue severity scale: Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989; 46(10): 1121–1123.

19.

Fisk

Pontefract

Ritvo

. The impact of fatigue on patients with multiple sclerosis. Can J Neurol Sci 1994; 21: 9–14.

20.

Buysse

Reynolds

Monk

. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiat Res 1989; 28(2): 193–213.

21.

Hurwitz

Coryell

Parker

. Chronic fatigue syndrome: Illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function. Clin Sci 2009; 118(2): 125–135.

22.

Ross

Medow

Rowe

. What is brain fog? An evaluation of the symptom in postural tachycardia syndrome. Clin Auton Res 2013; 23(6): 305–311.

23.

Bear

Philipp

Hill

. A preliminary study on how hypohydration affects pain perception. Psychophysiology 2016; 53: 605–610.

24.

Krupp

Coyle

Doscher

. Fatigue therapy in multiple sclerosis: Results of a double-blind, randomized, parallel trial of amantadine, pemoline, and placebo. Neurology 1995; 45: 1956–1961.

25.

Bottin

Lemetais

Poupin

. Equivalence of afternoon spot and 24-h urinary hydration biomarkers in free-living healthy adults. Eur J Clin Nutr. Epub ahead of print 13 January 2016. DOI: 10.1038/ejcn.2015.217.

26.

Perrier

Demazières

Girard

. Circadian variation and responsiveness of hydration biomarkers to changes in daily water intake. Eur J Appl Physiol 2013; 113(8): 2143–2151.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.11 MB

0.10 MB