Evidence mapPaperPMID 41866618Full record

ArticlePflugers Archiv : European journal of physiology2026

Low fruit and vegetable intake in children: a dietary stressor raising renal ammonium and adrenal cortisol secretion.

Thomas Remer, Yifan Hua, Jonas Esche, Lijie Shi, Michaela F Hartmann, Stefan A Wudy

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Article in Pflugers Archiv : European journal of physiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Thomas Remer *DONALD Study Center, Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Heinstück 11, Dortmund, 44225, Germany. remer@uni-bonn.de.ORCID http://orcid.org/0000-0002-0241-1909
Yifan Hua *DONALD Study Center, Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Heinstück 11, Dortmund, 44225, Germany.
Jonas EscheFormerly at DONALD Study Center, Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Dortmund, Germany.
Lijie ShiFormerly at DONALD Study Center, Nutritional Epidemiology, Institute of Nutrition and Food Science, University of Bonn, Dortmund, Germany.
Michaela F HartmannLaboratory for Translational Hormone Analytics, Steroid Research & Mass Spectrometry Unit, Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany.
Stefan A WudyLaboratory for Translational Hormone Analytics, Steroid Research & Mass Spectrometry Unit, Pediatric Endocrinology & Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Elimination of excess acid loads in metabolic acidosis requires stimulation of ammoniagenesis. Cortisol is critical to increase proximal tubular cells’ ammonia production. We aimed to specifically examine whether children’s low fruit and vegetable (FV) intake, which goes along with an increased dietary acid load, may raise cortisol secretion and whether glucocorticoids relevantly associate with ammonium secretion. Healthy 6–10 years old children (participants of the DONALD study, Dortmund, Germany) with a comparable protein intake and either a low or a high FV-intake were examined in a quasi-experimental design. Urinary 24-h ammonium excretion was analyzed as part of urinary acid-base measurements. Major glucocorticoid metabolites were quantified along with aldosterone precursors in children’s 24-h urine samples by gas chromatography–mass spectrometry to assess adrenal cortisol secretion and aldosterone status. Liquid–chromatography–mass spectrometry was used to quantify urinary free cortisol (UFF) and cortisone. Average FV-intake of children with low compared to high FV-intake was 183 g/d (25th -75th percentile, 129–233 g/d) and 570 g/d (25th -75th percentile, 468–707 g/d), respectively. Both groups’ average protein intake amounted to around 50 g/d. After adjustment for relevant confounders, children with low FV-intake exhibited higher excretion rates of UFF (P = 0.002), cortisone (P = 0.07), potentially bioactive free glucocorticoids (sum of UFF and cortisone) (P = 0.04), 20α-dihydrocortisol (P = 0.02), C21-metabolite sum reflecting cortisol secretion (P = 0.008), and ammonium (P < 0.0001). Concurrently with these children’s lower potassium intake, excretions of the aldosterone precursors tetrahydro-11-dehydrocorticosterone and tetrahydrocorticosterone were reduced (P ≤ 0.02). Urinary ammonium excretion associated closely with UFF (P < 0.0001), cortisone (P < 0.0001), and 20α-dihydrocortisol (P = 0.0003). Our quasi-experimental study indicates the importance of an appropriately high FV-intake in childhood to reduce acid-load-inducible cortisol-increases that are strongly associated with renal ammonium production and may have the potential to adversely affect long-term health.

Indexed as

Adrenal GlandsAmmonium CompoundsFruitHydrocortisoneKidneyVegetablesAldosteroneChildDietFemaleHumansMaleAldosteroneAmmonium CompoundsHydrocortisoneAmmonium excretionCortisolDietary acid loadFruit and vegetable intakeGlucocorticoid secretionNet acid excretionRenal stress

Identifiers

PMID41866618
PMCPMC13006471

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.