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<title>The American Journal of Clinical Nutrition Volume 155 Issue 1 2025</title>
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<publisher>2025</publisher>
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<edition>Volume 155 Issue 1 2025</edition>
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<note>Background: Epidemiologic evidence linking blood pressure (BP) and body weight-lowering effects with fruit and vegetable consumption
mostly relies on self-reported dietary assessment prone to misreport and under- or overestimation of relationships.
Objectives: We aimed to characterize objective 24-h urinary metabolites and a derived metabolite score associated with fruit and vegetable
intake and assessed their associations with BP and BMI, with validation across cohorts.
Methods: We used untargeted proton nuclear magnetic resonance spectroscopy (1

H NMR) of 2 timed repeated 24-h urine collections from
free-living participants from the US (n 1&frasl;4 2032) and the UK (n 1&frasl;4 449) of the cross-sectional International Study of Macro-/Micronutrients
and Blood Pressure (INTERMAP). We evaluated correlations between fruit and vegetable intake assessed by 24-h dietary recalls with 7100
1
H NMR features, adjusted for confounders and multiple testing. We related identified metabolites and a metabolite score with BP and BMI
using extensively adjusted multiple linear regression models.
Results: We characterized 11 1

H NMR-derived 24-h urinary metabolites related to fruit and vegetable intake, reproducible across multiple
24-h urine collections of both cohorts. Proline betaine, citrate, N-methylproline, scyllo-inositol, 2-hydroxy-2-(4-methyl cyclohex-3-en-1-yl)
propoxyglucuronide, and proline were associated with fruit intake, specifically with Rutaceae intake, whereas S-methyl-L-cysteine sulfoxide
and S-methyl-L-cysteine sulfoxide metabolite were associated with Brassicaceae intake. The metabolite score, explaining 39.8% of fruit and
vegetable intake, was inversely associated with systolic BP [1.65 mmHg; 95% confidence interval (CI): 2.68, 0.62; P &lt; 0.002] and BMI
(1.21 kg/m2

; 95% CI: 1.62, 0.78; P &lt; 0.0001). These associations were, to a large extent, explained by urinary citrate excretion.

Conclusions: We identified 1

H NMR-derived urinary metabolites associated with fruit and vegetable consumption, consistent and repro-
ducible between urine collections and across populations. A higher fruit and vegetable-related metabolite score showed associations with

lower systolic BP and BMI, mainly mediated by citrate, but would need confirmation in further studies.
Keywords: Biomarkers, blood pressure, body mass index, cardiovascular disease risk factors, 24-h dietary recalls, fruit and vegetables,
urinary metabolites</note>
<subject authority=""><topic>Clinical Nutrition</topic></subject>
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