{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:37:31Z","timestamp":1785213451757,"version":"3.55.0"},"reference-count":49,"publisher":"National Athletic Trainers' Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n          <jats:title>Objective<\/jats:title>\n          <jats:p>Dehydration associated with exertion is a commonly encountered condition in the first aid setting, particularly at outdoor sporting events. Part I of this systematic review demonstrated that commercial sports drinks can be suggested for effective restoration of fluid balance in dehydrated people. In part II, we perform a systematic review to compare alternative liquids, such as cow\u2019s milk, beer, and coconut water, with water for effective oral rehydration after prolonged exercise.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Data Sources<\/jats:title>\n          <jats:p>Cochrane Library, MEDLINE via the PubMed interface, and Embase databases were searched up until June 1, 2022.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Study Selection<\/jats:title>\n          <jats:p>Controlled experimental and observational studies involving adults and children were included when dehydration was induced by physical exercise and oral rehydration fluids were administered and compared with regular water. No additional food intake accompanied the rehydration drinks or water. Articles in all languages were included if an English abstract was available.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Data Extraction<\/jats:title>\n          <jats:p>Study design, study population, intervention, outcome measures, and study limitations were extracted from each included article.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Data Synthesis<\/jats:title>\n          <jats:p>Of 3485 articles screened, 11 articles in which authors compared skim or low-fat cow\u2019s milk, coconut water, or beer (0%\u20135% alcohol) with water were included. Authors of 4 studies showed that drinking skim or low-fat milk, without additional food intake, led to improved volume\/hydration status compared with drinking water. Authors of 3 trials showed no differences at multiple times for outcomes related to volume\/hydration status after rehydration with fresh coconut water compared with water. Evidence to recommend beer (0%\u20135% alcohol) for rehydration is insufficient.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Conclusions<\/jats:title>\n          <jats:p>Consuming skim or low-fat cow\u2019s milk without additional food intake as compared with water appears to improve volume\/hydration status in people with exercise-induced dehydration. However, evidence is of very low certainty and should be interpreted with caution.<\/jats:p>\n        <\/jats:sec>","DOI":"10.4085\/1062-6050-0686.22","type":"journal-article","created":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T12:05:37Z","timestamp":1703073937000},"page":"55-69","source":"Crossref","is-referenced-by-count":5,"title":["Oral Rehydration Beverages for Treating Exercise-Associated Dehydration: A Systematic Review, Part II. The Effectiveness of Alternatives to Carbohydrate-Electrolyte Drinks"],"prefix":"10.4085","volume":"60","author":[{"given":"Niels","family":"De Brier","sequence":"first","affiliation":[{"name":"Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium"},{"name":"Department of Public Health and Primary Care, Leuven Institute of Healthcare Policy, KU Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vere","family":"Borra","sequence":"additional","affiliation":[{"name":"Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium"},{"name":"Department of Public Health and Primary Care, Leuven Institute of Healthcare Policy, KU Leuven, Belgium"},{"name":"Cochrane First Aid, Mechelen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Berry","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, College of Health and Human Services, Saginaw Valley State University, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Zideman","sequence":"additional","affiliation":[{"name":"Thames Valley Air Ambulance, Stokenchurch, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunice","family":"Singletary","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmy","family":"De Buck","sequence":"additional","affiliation":[{"name":"Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium"},{"name":"Department of Public Health and Primary Care, Leuven Institute of Healthcare Policy, KU Leuven, Belgium"},{"name":"Cochrane First Aid, Mechelen, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"_","family":"_","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2557","reference":[{"issue":"9","key":"i1938-162X-60-1-55-b01","series-title":"J Athl Train","first-page":"877","article-title":"National Athletic Trainers\u2019 Association position statement: fluid replacement for the physically active","volume":"52","author":"McDermott","year":"2017","unstructured":"McDermott\n              BP,\n            \n            \n              Anderson\n              SA,\n            \n            \n              Armstrong\n              LE,\n            \n            et al.\n          \n          National Athletic Trainers\u2019 Association position statement: fluid replacement for the physically active. J Athl Train. 2017;52(9):877\u2013895. doi:10.4085\/1062-6050-52.9.02"},{"issue":"suppl 4","key":"i1938-162X-60-1-55-b02","series-title":"Aust J Nutr Diet","first-page":"S13","article-title":"Sweat losses during various sports","volume":"53","author":"Rehrer","year":"1996","unstructured":"Rehrer\n              NJ,\n            \n            \n              Burke\n              LM.\n            \n          \n          Sweat losses during various sports. Aust J Nutr Diet. 1996;53(suppl 4):S13\u2013S16."},{"issue":"2","key":"i1938-162X-60-1-55-b03","series-title":"Med Sci Sports Exerc","first-page":"377","article-title":"American College of Sports Medicine position stand. Exercise and fluid replacement","volume":"39","author":"American College of Sports Medicine","year":"2007","unstructured":"American College of Sports Medicine; SawkaMN,BurkeLM,EichnerER,MaughanRJ,MontainSJ,StachenfeldNS.\n          American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc. 2007;39(2):377\u2013390. doi:10.1249\/mss.0b013e31802ca597"},{"issue":"9","key":"i1938-162X-60-1-55-b04","series-title":"J Athl Train","first-page":"986","article-title":"National Athletic Trainers\u2019 Association position statement: exertional heat illnesses","volume":"50","author":"Casa","year":"2015","unstructured":"Casa\n              DJ,\n            \n            \n              DeMartini\n              JK,\n            \n            \n              Bergeron\n              MF,\n            \n            et al.\n          \n          National Athletic Trainers\u2019 Association position statement: exertional heat illnesses. J Athl Train. 2015;50(9):986\u20131000. doi:10.4085\/1062-6050-50.9.07. 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Med Sci Sports Exerc. 2018;50(11):2360\u20132368. doi:10.1249\/MSS.0000000000001682"},{"issue":"3","key":"i1938-162X-60-1-55-b06","series-title":"J Acad Nutr Diet","first-page":"501","article-title":"Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: nutrition and athletic performance","volume":"116","author":"Thomas","year":"2016","unstructured":"Thomas\n              DT,\n            \n            \n              Erdman\n              KA,\n            \n            \n              Burke\n              LM.\n            \n          \n          Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: nutrition and athletic performance. 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Eur J Appl Physiol Occup Physiol. 1995;71(4):311\u2013319. doi:10.1007\/BF00240410"},{"issue":"1","key":"i1938-162X-60-1-55-b08","series-title":"J Appl Physiol (1985)","first-page":"325","article-title":"Role of osmolality and plasma volume during rehydration in humans","volume":"65","author":"Nose","year":"1988","unstructured":"Nose\n              H,\n            \n            \n              Mack\n              GW,\n            \n            \n              Shi\n              X,\n            \n            \n              Nadel\n              ER.\n            \n          \n          Role of osmolality and plasma volume during rehydration in humans. 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Med Sci Sports Exerc. 1996;28(10):1260\u20131271. doi:10.1097\/00005768-199610000-00009"},{"issue":"suppl 1","key":"i1938-162X-60-1-55-b10","series-title":"J Sports Sci","first-page":"117","article-title":"Fluid and electrolyte loss and replacement in exercise","volume":"9","author":"Maughan","year":"1991","unstructured":"Maughan\n              RJ.\n            \n          \n          Fluid and electrolyte loss and replacement in exercise. J Sports Sci. 1991;9(suppl 1):117\u2013142. doi:10.1080\/02640419108729870"},{"issue":"6","key":"i1938-162X-60-1-55-b11","series-title":"J Appl Physiol","first-page":"1847","article-title":"Sodium-free fluid ingestion decreases plasma sodium during exercise in the heat","volume":"86","author":"Vrijens","year":"1999","unstructured":"Vrijens\n              DM,\n            \n            \n              Rehrer\n              NJ.\n            \n          \n          Sodium-free fluid ingestion decreases plasma sodium during exercise in the heat. J Appl Physiol. 1999;86(6):1847\u20131851. doi:10.1152\/jappl.1999.86.6.1847"},{"key":"i1938-162X-60-1-55-b12","series-title":"Brenner & Rector\u2019s The Kidney","article-title":"Disorders of water balance","author":"Verbalis","year":"2020","unstructured":"Verbalis\n              JG.\n            \n          \n          Disorders of water balance. In: YuASL,ChertowGM,LuyckxVA,MarsdenPA,SkoreckiK,TaalMW, eds. Brenner & Rector\u2019s The Kidney. 11th ed.Elsevier; 2020."},{"issue":"9","key":"i1938-162X-60-1-55-b13","series-title":"Eur J Clin Nutr","first-page":"939","article-title":"Relation between urinary hydration biomarkers and total fluid intake in healthy adults","volume":"67","author":"Perrier","year":"2013","unstructured":"Perrier\n              E,\n            \n            \n              Rondeau\n              P,\n            \n            \n              Poupin\n              M,\n            \n            et al.\n          \n          Relation between urinary hydration biomarkers and total fluid intake in healthy adults. Eur J Clin Nutr. 2013;67(9):939\u2013943. doi:10.1038\/ejcn.2013.93"},{"issue":"9","key":"i1938-162X-60-1-55-b14","series-title":"Br J Nutr","first-page":"1678","article-title":"Hydration biomarkers in free-living adults with different levels of habitual fluid consumption","volume":"109","author":"Perrier","year":"2013","unstructured":"Perrier\n              E,\n            \n            \n              Vergne\n              S,\n            \n            \n              Klein\n              A,\n            \n            et al.\n          \n          Hydration biomarkers in free-living adults with different levels of habitual fluid consumption. Br J Nutr. 2013;109(9):1678\u20131687. doi:10.1017\/S0007114512003601"},{"key":"i1938-162X-60-1-55-b15","series-title":"J Athl Train","article-title":"Oral rehydration beverages for treating exercise-associated dehydration: a systematic review. Part I: carbohydrate-electrolyte solutions","author":"Borra","year":"2023","unstructured":"Borra\n              V,\n            \n            \n              De Brier\n              N,\n            \n            \n              Berry\n              DC,\n            \n            \n              Zideman\n              D,\n            \n            \n              Singletary\n              EM,\n            \n            \n              De Buck\n              E;\n            \n            International Liaison Committee on Resuscitation First Aid Task Force\n          . Oral rehydration beverages for treating exercise-associated dehydration: a systematic review. Part I: carbohydrate-electrolyte solutions. J Athl Train. Published online December 20, 2023. doi:10.4085\/1062-6050-0682.22"},{"key":"i1938-162X-60-1-55-b16","series-title":"Resuscitation","first-page":"278","article-title":"European Resuscitation Council guidelines for resuscitation 2015 section 9. 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Resuscitation. 2015;95:278\u2013287. doi:10.1016\/j.resuscitation.2015.07.031"},{"issue":"6","key":"i1938-162X-60-1-55-b17","series-title":"Br J Nutr","first-page":"1013","article-title":"A metered intake of milk following exercise and thermal dehydration restores whole-body net fluid balance better than a carbohydrate-electrolyte solution or water in healthy young men","volume":"116","author":"Seery","year":"2016","unstructured":"Seery\n              S,\n            \n            \n              Jakeman\n              P.\n            \n          \n          A metered intake of milk following exercise and thermal dehydration restores whole-body net fluid balance better than a carbohydrate-electrolyte solution or water in healthy young men. Br J Nutr. 2016;116(6):1013\u20131021. doi:10.1017\/S0007114516002907"},{"issue":"2","key":"i1938-162X-60-1-55-b18","series-title":"Int J Sport Nutr Exerc Metab","first-page":"128","article-title":"Effect of drinking rate on the retention of water or milk following exercise-induced dehydration","volume":"30","author":"Sayer","year":"2020","unstructured":"Sayer\n              L,\n            \n            \n              Rodriguez-Sanchez\n              N,\n            \n            \n              Rodriguez-Giustiniani\n              P,\n            \n            et al.\n          \n          Effect of drinking rate on the retention of water or milk following exercise-induced dehydration. Int J Sport Nutr Exerc Metab. 2020;30(2):128\u2013138. doi:10.1123\/ijsnem.2019-0176"},{"issue":"4","key":"i1938-162X-60-1-55-b19","series-title":"Southeast Asian J Trop Med Public Health","first-page":"769","article-title":"Rehydration with sodium-enriched coconut water after exercise-induced dehydration","volume":"38","author":"Ismail","year":"2007","unstructured":"Ismail\n              I,\n            \n            \n              Singh\n              R,\n            \n            \n              Sirisinghe\n              RG.\n            \n          \n          Rehydration with sodium-enriched coconut water after exercise-induced dehydration. Southeast Asian J Trop Med Public Health. 2007;38(4):769\u2013785."},{"issue":"2","key":"i1938-162X-60-1-55-b20","series-title":"J Physiol Anthropol Appl Human Sci","first-page":"93","article-title":"Rehydration after exercise with fresh young coconut water, carbohydrate-electrolyte beverage and plain water","volume":"21","author":"Saat","year":"2002","unstructured":"Saat\n              M,\n            \n            \n              Singh\n              R,\n            \n            \n              Sirisinghe\n              RG,\n            \n            \n              Nawawi\n              M.\n            \n          \n          Rehydration after exercise with fresh young coconut water, carbohydrate-electrolyte beverage and plain water. J Physiol Anthropol Appl Human Sci. 2002;21(2):93\u2013104. doi:10.2114\/jpa.21.93"},{"issue":"12","key":"i1938-162X-60-1-55-b21","series-title":"Molecules","first-page":"5144","article-title":"The chemical composition and biological properties of coconut (Cocos nucifera L.) water","volume":"14","author":"Yong","year":"2009","unstructured":"Yong\n              JW,\n            \n            \n              Ge\n              L,\n            \n            \n              Ng\n              YF,\n            \n            \n              Tan\n              SN.\n            \n          \n          The chemical composition and biological properties of coconut (Cocos nucifera L.) water. Molecules. 2009;14(12):5144\u20135164. doi:10.3390\/molecules14125144"},{"issue":"10","key":"i1938-162X-60-1-55-b22","series-title":"Appl Physiol Nutr Metab","first-page":"1175","article-title":"Postexercise rehydration with beer impairs fluid retention, reaction time, and balance","volume":"39","author":"Flores-Salamanca","year":"2014","unstructured":"Flores-Salamanca\n              R,\n            \n            \n              Arag\u00f3n-Vargas\n              LF.\n            \n          \n          Postexercise rehydration with beer impairs fluid retention, reaction time, and balance. Appl Physiol Nutr Metab. 2014;39(10):1175\u20131181. doi:10.1139\/apnm-2013-0576"},{"key":"i1938-162X-60-1-55-b23","series-title":"J Int Soc Sports Nutr","first-page":"26","article-title":"Effects of a moderate intake of beer on markers of hydration after exercise in the heat: a crossover study","volume":"12","author":"Jim\u00e9nez-Pav\u00f3n","year":"2015","unstructured":"Jim\u00e9nez-Pav\u00f3n\n              D,\n            \n            \n              Cervantes-Borunda\n              MS,\n            \n            \n              D\u00edaz\n              LE,\n            \n            \n              Marcos\n              A,\n            \n            \n              Castillo\n              MJ.\n            \n          \n          Effects of a moderate intake of beer on markers of hydration after exercise in the heat: a crossover study. 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PLoS Med. 2009;6(7):e1000097. doi:10.1371\/journal.pmed.1000097"},{"key":"i1938-162X-60-1-55-b25","series-title":"Front Nutr","first-page":"45","article-title":"Post-exercise rehydration: effect of consumption of beer with varying alcohol content on fluid balance after mild dehydration","volume":"3","author":"Wijnen","year":"2016","unstructured":"Wijnen\n              AH,\n            \n            \n              Steennis\n              J,\n            \n            \n              Catoire\n              M,\n            \n            \n              Wardenaar\n              FC,\n            \n            \n              Mensink\n              M.\n            \n          \n          Post-exercise rehydration: effect of consumption of beer with varying alcohol content on fluid balance after mild dehydration. 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Appl Physiol Nutr Metab. 2014;39(11):1257\u20131264. doi:10.1139\/apnm-2014-0047"},{"issue":"1","key":"i1938-162X-60-1-55-b28","series-title":"J Int Soc Sports Nutr","first-page":"1","article-title":"Comparison of coconut water and a carbohydrate-electrolyte sport drink on measures of hydration and physical performance in exercise-trained men","volume":"9","author":"Kalman","year":"2012","unstructured":"Kalman\n              DS,\n            \n            \n              Feldman\n              S,\n            \n            \n              Krieger\n              DR,\n            \n            \n              Bloomer\n              RJ.\n            \n          \n          Comparison of coconut water and a carbohydrate-electrolyte sport drink on measures of hydration and physical performance in exercise-trained men. 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Appl Physiol Nutr Metab. 2014;39(10):1167\u20131174. doi:10.1139\/apnm-2013-0434"},{"key":"i1938-162X-60-1-55-b30","series-title":"Cochrane Handbook for Systematic Reviews of Interventions","article-title":"Chapter 23: including variants on randomized trials","author":"Higgins","year":"2022","unstructured":"Higgins\n              JPT,\n            \n            \n              Eldridge\n              S,\n            \n            \n              Li\n              T.\n            \n          \n          Chapter 23: including variants on randomized trials. In: HigginsJPT,ThomasJ,ChandlerJ,et al. eds. Cochrane Handbook for Systematic Reviews of Interventions. Version 6.3 (updated February 2022). Cochrane; 2022. https:\/\/training.cochrane.org\/handbook\/archive\/v6.3\/chapter-23"},{"issue":"7650","key":"i1938-162X-60-1-55-b31","series-title":"BMJ","first-page":"924","article-title":"GRADE Working Group. 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Int J Sport Nutr. 1999;9(3):263\u2013274. doi:10.1123\/ijsn.9.3.263"},{"issue":"pt 2","key":"i1938-162X-60-1-55-b35","series-title":"J Physiol","first-page":"523","article-title":"The effect of osmolality and carbohydrate content on the rate of gastric emptying of liquids in man","volume":"486","author":"Vist","year":"1995","unstructured":"Vist\n              GE,\n            \n            \n              Maughan\n              RJ.\n            \n          \n          The effect of osmolality and carbohydrate content on the rate of gastric emptying of liquids in man. J Physiol. 1995;486(pt 2):523\u2013531. doi:10.1113\/jphysiol.1995.sp020831"},{"issue":"1","key":"i1938-162X-60-1-55-b36","series-title":"Int J Sport Nutr Exerc Metab","first-page":"79","article-title":"Effect of drink carbohydrate content on postexercise gastric emptying, rehydration, and the calculation of net fluid balance","volume":"24","author":"Clayton","year":"2014","unstructured":"Clayton\n              DJ,\n            \n            \n              Evans\n              GH,\n            \n            \n              James\n              LJ.\n            \n          \n          Effect of drink carbohydrate content on postexercise gastric emptying, rehydration, and the calculation of net fluid balance. Int J Sport Nutr Exerc Metab. 2014;24(1):79\u201389. doi:10.1123\/ijsnem.2013-0024"},{"issue":"2","key":"i1938-162X-60-1-55-b37","series-title":"J Appl Physiol (1985)","first-page":"245","article-title":"Carbohydrate exerts a mild influence on fluid retention following exercise-induced dehydration","volume":"108","author":"Osterberg","year":"2010","unstructured":"Osterberg\n              KL,\n            \n            \n              Pallardy\n              SE,\n            \n            \n              Johnson\n              RJ,\n            \n            \n              Horswill\n              CA.\n            \n          \n          Carbohydrate exerts a mild influence on fluid retention following exercise-induced dehydration. J Appl Physiol (1985). 2010;108(2):245\u2013250. doi:10.1152\/japplphysiol.91275.2008"},{"issue":"6","key":"i1938-162X-60-1-55-b38","series-title":"Scand J Med Sci Sports","first-page":"364","article-title":"Sports, physical exercise and use of alcohol","volume":"5","author":"Watten","year":"1995","unstructured":"Watten\n              RG.\n            \n          \n          Sports, physical exercise and use of alcohol. Scand J Med Sci Sports. 1995;5(6):364\u2013368. doi:10.1111\/j.1600-0838.1995.tb00060.x"},{"issue":"3","key":"i1938-162X-60-1-55-b39","series-title":"J Physiol","first-page":"379","article-title":"The diuretic action of alcohol and its relation to pituitrin","volume":"76","author":"Murray","year":"1932","unstructured":"Murray\n              MM.\n            \n          \n          The diuretic action of alcohol and its relation to pituitrin. 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J Appl Physiol (1985).1997;83(4):1152\u20131158. doi:10.1152\/jappl.1997.83.4.1152"},{"issue":"3","key":"i1938-162X-60-1-55-b41","series-title":"Int J Sport Nutr Exerc Metab","first-page":"262","article-title":"Manipulations to the alcohol and sodium content of beer for postexercise rehydration","volume":"25","author":"Desbrow","year":"2015","unstructured":"Desbrow\n              B,\n            \n            \n              Cecchin\n              D,\n            \n            \n              Jones\n              A,\n            \n            \n              Grant\n              G,\n            \n            \n              Irwin\n              C,\n            \n            \n              Leveritt\n              M.\n            \n          \n          Manipulations to the alcohol and sodium content of beer for postexercise rehydration. 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Circulation. 2022;145(9):e645\u2013e721. doi:10.1161\/CIR.0000000000001017. Published correction appears in Circulation. 2022;145(9):e760."},{"issue":"22","key":"i1938-162X-60-1-55-b44","series-title":"Chin Med J (Engl)","first-page":"3220","article-title":"Effects of a carbohydrate-electrolyte beverage on blood viscosity after dehydration in healthy adults","volume":"123","author":"Chang","year":"2010","unstructured":"Chang\n              CQ,\n            \n            \n              Chen\n              YB,\n            \n            \n              Chen\n              ZM,\n            \n            \n              Zhang\n              LT.\n            \n          \n          Effects of a carbohydrate-electrolyte beverage on blood viscosity after dehydration in healthy adults. 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Int J Sport Nutr Exerc Metab. 2011;21(4):300\u2013310. doi:10.1123\/ijsnem.21.4.300"},{"issue":"3\u20134","key":"i1938-162X-60-1-55-b49","series-title":"Eur J Appl Physiol Occup Physiol","first-page":"317","article-title":"Restoration of fluid balance after exercise-induced dehydration: effects of food and fluid intake","volume":"73","author":"Maughan","year":"1996","unstructured":"Maughan\n              RJ,\n            \n            \n              Leiper\n              JB,\n            \n            \n              Shirreffs\n              SM.\n            \n          \n          Restoration of fluid balance after exercise-induced dehydration: effects of food and fluid intake. 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