{
  "abstract": "Background: Higher fruit intake is associated with better cardiovascular health, but mechanisms remain unclear and may differ for whole fruit versus fruit juice. We evaluated the association between usual whole-fruit intake and predicted 10-year ASCVD risk and explored potential dietary and biochemical mediators.\n\nMethods: We analyzed 12,771 adults aged ≥40 years from NHANES 2007–2018 without prior cardiovascular disease. Usual whole-fruit intake (excluding juice) was estimated using the NCI multivariate method. The outcome was logit-transformed 10-year ASCVD risk based on the Pooled Cohort Equations. A high-dimensional mediation framework was applied to identify a latent mediator from multiple dietary and biomarker variables using machine learning (ridge regression, support vector regression, gradient boosting, and deep learning). Effects were estimated in a test set with bootstrapping and multiple imputations.\n\nResults: Fruit consumers differed from non-consumers in socio-demographic and lifestyle characteristics, including lower smoking prevalence and obesity. Higher whole-fruit intake was associated with lower ASCVD risk. An increase of 80 g/day (one portion) corresponded to a total effect of − 0.037 (95% CI: −0.059, −0.015; p = 0.001), with consistent direct effects across models (−0.033 to − 0.037; p ≤ 0.002). Indirect effects were small and model-dependent; only gradient boosting detected a significant mediated effect (−0.003; p = 0.019), accounting for 8% of the total effect. Key contributors included eGFR, total energy intake, sodium, cured meat, and legumes/soy.\n\nConclusions: Higher whole-fruit intake was associated with lower predicted ASCVD risk, largely independent of the evaluated mediators. Findings suggest that whole-fruit intake reflects broader dietary and metabolic patterns rather than a single causal pathway.\n\nKey messages: • Higher whole-fruit intake is associated with lower predicted 10-year cardiovascular risk in US adults, supporting current dietary recommendations.\n\n• The association is only weakly mediated, suggesting fruit intake reflects broader healthy dietary and metabolic patterns rather than a single pathway.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "abstract",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "name": "A Llane"
    },
    {
      "name": "D Zampieri"
    },
    {
      "name": "H Ocagli"
    },
    {
      "name": "C Dente"
    },
    {
      "name": "F Fortuna"
    },
    {
      "name": "G Lorenzoni"
    },
    {
      "name": "D Gregori"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fz8jzw9b665b5.bib",
  "cited_by": 0,
  "doi": "10.1093/eurpub/ckag169.1335",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13698328/",
  "id": "fz8jzw9b665b5",
  "issns": [
    "1101-1262",
    "1464-360X"
  ],
  "landing_url": "https://doi.org/10.1093/eurpub/ckag169.1335",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "6. Poster Displays"
    ],
    [
      "heading",
      "AcademicSubjects/MED00860"
    ],
    [
      "heading",
      "AcademicSubjects/SOC01210"
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    [
      "heading",
      "AcademicSubjects/SOC02610"
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    [
      "heading",
      "DH. Food, nutrition and diet"
    ],
    [
      "openalex",
      "2739|Nutritional Studies and Diet"
    ]
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  "openalex": "W7223659822",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13698328/pdf/?tool=EBI",
  "pmcid": "PMC13698328",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/fz8jzw9b665b5.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:14Z",
      "native_id": "PMC13698328",
      "source": "pmc",
      "url": "https://doi.org/10.1093/eurpub/ckag169.1335"
    },
    {
      "first_seen": "2026-10-30T12:21:44Z",
      "native_id": "PMC:PMC13698328",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13698328"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2739|Nutritional Studies and Diet",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Whole fruit intake and 10-year ASCVD risk: mediation analysis in NHANES",
  "title_text": "Whole fruit intake and 10-year ASCVD risk: mediation analysis in NHANES",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:35:12Z",
  "url": "https://research.draconitic.com/paper/fz8jzw9b665b5",
  "venue": "The European Journal of Public Health",
  "versions": []
}