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Cortisol is critical to increase proximal tubular cells\u2019 ammonia production. We aimed to specifically examine whether children\u2019s 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\u201310 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\u2019s 24-h urine samples by gas chromatography\u2013mass spectrometry to assess adrenal cortisol secretion and aldosterone status. Liquid\u2013chromatography\u2013mass 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\u00a0g\/d (25th -75th percentile, 129\u2013233 g\/d) and 570\u00a0g\/d (25th -75th percentile, 468\u2013707\u00a0g\/d), respectively. Both groups\u2019 average protein intake amounted to around 50\u00a0g\/d. After adjustment for relevant confounders, children with low FV-intake exhibited higher excretion rates of UFF (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.002), cortisone (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.07), potentially bioactive free glucocorticoids (sum of UFF and cortisone) (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.04), 20\u03b1-dihydrocortisol (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.02), C21-metabolite sum reflecting cortisol secretion (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.008), and ammonium (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.0001). Concurrently with these children\u2019s lower potassium intake, excretions of the aldosterone precursors tetrahydro-11-dehydrocorticosterone and tetrahydrocorticosterone were reduced (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009\u2264\u20090.02). Urinary ammonium excretion associated closely with UFF (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.0001), cortisone (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.0001), and 20\u03b1-dihydrocortisol (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009=\u20090.0003). 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.\n                  <\/jats:p>","DOI":"10.1007\/s00424-026-03162-3","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T01:39:03Z","timestamp":1774229943000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Low fruit and vegetable intake in children: a dietary stressor raising renal ammonium and adrenal cortisol secretion"],"prefix":"10.1007","volume":"478","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0241-1909","authenticated-orcid":false,"given":"Thomas","family":"Remer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Hua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Esche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijie","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela F.","family":"Hartmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan A.","family":"Wudy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,23]]},"reference":[{"key":"3162_CR1","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.kint.2016.04.011","volume":"90","author":"ID Weiner","year":"2016","unstructured":"Weiner ID (2016) Untangling the complex relationship between dietary acid load and glucocorticoid metabolism. 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