Impact of 100% Fruit Juice Consumption on Diet and Weight Status of Children: An Evidence-based Review

Association Between Child Sugary Drink Consumption and Serum Lipid Levels in Electronic Health Records

Sugar-sweetened beverage (SSB) and fruit juice (FJ) consumption may promote lipid abnormalities in childhood. We examined the association between SSB/FJ intake and lipid levels using electronic health record data for 2816 adolescents. Multivariable logistic regression models treated clinical cutpoints for abnormal lipid levels (triglycerides [TG], high-density lipoprotein (HDL), low-density lipoprotein [LDL], and total cholesterol) as dependent variables. In models not adjusted for adiposity, elevated SSB and FJ consumption was associated with increased odds of having abnormally high TG (SSB: odds ratio [OR] = 1.28 (95% confidence interval [CI] = [1.07-1.52], P = .007); FJ: 1.35 ([1.09-1.69], P = .007)) and abnormally low HDL (SSB: 1.47 ([1.17-1.86], P = .001); FJ: 1.35 ([1.02-1.78], P = .03)). Adjusting for adiposity, a likely mediator of the relationship, attenuated these associations. These findings support the need for identifying unhealthy beverage consumption habits during childhood health care visits as a modifiable behavior associated with cardiometabolic risk.

Health effects of 100% fruit and vegetable juices: evidence from human subject intervention studies

The health effects of 100% fruit and vegetable juices (FVJ) represent a controversial topic. FVJ contain notable amounts of free sugars, but also vitamins, minerals, and secondary compounds with proven biological activities like (poly)phenols and carotenoids. The review aimed to shed light on the potential impact of 100% FVJ on human subject health, comprehensively assessing the role each type of juice may have in specific health outcomes for a particular target population, as reported in dietary interventions. The effects of a wide range of FVJ (orange, grapefruit, mandarin, lemon, apple, white, red, and Concord grapes, pomegranate, cranberry, chokeberry, blueberry, other minor berries, sweet and tart cherry, plum, tomato, carrot, beetroot, and watermelon, among others) were evaluated on a series of outcomes (anthropometric parameters, body composition, blood pressure and vascular function, lipid profile, glucose homeostasis, biomarkers of inflammation and oxidative stress, cognitive function, exercise performance, gut microbiota composition and bacterial infections), providing a thorough picture of the contribution of each FVJ to a health outcome. Some juices demonstrated their ability to exert potential preventive effects on some outcomes while others on other health outcomes, emphasising how the differential composition in bioactive compounds defines juice effects. Research gaps and future prospects were discussed. Although 100% FVJ appear to have beneficial effects on some cardiometabolic health outcomes, cognition and exercise performance, or neutral effects on anthropometric parameters and body composition, further efforts are needed to better understand the impact of 100% FVJ on human subject health.

Beverage Consumption and Factors Influencing the Choice of Beverages among Polish Children Aged 11-13 Years in 2018-2023

Adequate hydration is essential for good health, and an individual's hydration status is determined by the quantity and type of ingested fluids. The aim of the present study was to determine the hydration status of school-age children and evaluate changes in the type and quantity of consumed beverages between 2018 and 2023. The study was conducted in two stages between 2018 and 2023, and a total of 1030 fully completed questionnaires were returned by the children and their parents. A comparison of the parents' responses regarding factors that affect beverage choices revealed that beverage composition was more significant for the parents in 2023 than in 2018, whereas health-promoting properties were significant for only less than 30% of the respondents. Taste preferences were important for both the parents and the children, and they were the main criterion in the choice of beverages in both 2018 and 2023. In turn, advertising was an important factor for children, and the percentage of children who were guided by advertising in their choice of beverages increased from 52.1% in 2018 to 58.5% in 2023 (p < 0.05). Daily fluid intake from beverages in children aged 11-13 years generally does not meet recommended intakes. Low fluid intake can negatively affect children's hydration status and bodily functions. Taste preferences and advertising were correlated with a higher intake of carbonated and non-carbonated sugar-sweetened beverages (SSBs) and dairy beverages. The percentage of children who bought drinks independently and had access to SSBs increased significantly during the analyzed period. Obtain results indicate that nutrition education programs are needed to teach adolescents to make healthy drink choices, limit their consumption of SSBs and EDs, and promote regular intake of natural mineral water and non-sweetened dairy beverages.

Consumption of 100% Fruit Juice and Body Weight in Children and Adults: A Systematic Review and Meta-Analysis

Importance

Concerns have been raised that frequent consumption of 100% fruit juice may promote weight gain. Current evidence on fruit juice and weight gain has yielded mixed findings from both observational studies and clinical trials.

Objective

To synthesize the available evidence on 100% fruit juice consumption and body weight in children and adults.

Data Sources

MEDLINE, Embase, and Cochrane databases were searched through May 18, 2023.

Study Selection

Prospective cohort studies of at least 6 months and randomized clinical trials (RCTs) of at least 2 weeks assessing the association of 100% fruit juice with body weight change in children and adults were included. In the trials, fruit juices were compared with noncaloric controls.

Data Extraction and Synthesis

Data were pooled using random-effects models and presented as β coefficients with 95% CIs for cohort studies and mean differences (MDs) with 95% CIs for RCTs.

Main Outcomes and Measures

Change in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was assessed in children and change in body weight in adults.

Results

A total of 42 eligible studies were included in this analysis, including 17 among children (17 cohorts; 0 RCTs; 45 851 children; median [IQR] age, 8 [1-15] years) and 25 among adults (6 cohorts; 19 RCTs; 268 095 adults; median [IQR] age among cohort studies, 48 [41-61] years; median [IQR] age among RCTs, 42 [25-59]). Among cohort studies in children, each additional serving per day of 100% fruit juice was associated with a 0.03 (95% CI, 0.01-0.05) higher BMI change. Among cohort studies in adults, studies that did not adjust for energy showed greater body weight gain (0.21 kg; 95% CI, 0.15-0.27 kg) than studies that did adjust for energy intake (-0.08 kg; 95% CI, -0.11 to -0.05 kg; P for meta-regression <.001). RCTs in adults found no significant association of assignment to 100% fruit juice with body weight but the CI was wide (MD, -0.53 kg; 95% CI, -1.55 to 0.48 kg).

Conclusion and Relevance

Based on the available evidence from prospective cohort studies, in this systematic review and meta-analysis, 1 serving per day of 100% fruit juice was associated with BMI gain among children. Findings in adults found a significant association among studies unadjusted for total energy, suggesting potential mediation by calories. Further trials of 100% fruit juice and body weight are desirable. Our findings support guidance to limit consumption of fruit juice to prevent intake of excess calories and weight gain.

Current perspectives and challenges in the estimation of fruit juice consumption across the lifecycle in Europe

Fruit juice (FJ) is typically low in energy, contains natural sugars, important amounts of micronutrients and is not permitted to have added sugars/sweeteners. However, its role in a healthy diet is under scrutiny partly due to the wider adoption of the definition for free sugars in nutrition policy. This review aimed to identify data on FJ consumption from national food consumption surveys across Europe, to examine current intakes, percent consumers and its contribution to intakes of energy, total sugars, free sugars, vitamin C, folate and potassium. Data were extracted on the population mean intake of FJ and its contribution to nutrient intakes across the lifecycle and crude estimates of population mean intakes across countries were reported for the total population and for consumers only. This review highlighted significant gaps/challenges regarding the availability of country-specific national food consumption surveys across Europe and specifically data on FJ consumption (including complexities surrounding categorisations). Nonetheless, using a comparable/homogenous definition, the mean intake of FJ among consumers was approximately 1 × 150 ml glass/day for adults/older adults, with lower intakes among infants (86 g/d), children (108 g/d) and teenagers (112 g/d). FJ made important contributions to intakes of vitamin C while making little contribution to energy intakes but also contributed 2-14 % of free sugars intake (which may be considered modest compared to other sources). The complexity of collating and interpreting data on FJ intake as elucidated in this review raises questions surrounding the categorisation of FJ in research and presents significant challenges for policymakers with respect to dietary guidance for FJ.

Is There a Convergence between the Food Classification Adopted by Food-Based Dietary Guidelines and Food Science and Technology?

The World Health Organization (WHO) proposed the dietary guidelines presented as the Food-based Dietary Guidelines (FBDG). The FBDG classify foods according to their origin, nature, nutrient source, food group, and processing level. Food science and technology (FST) ranks food according to its origin, perishability, nutrient source, processing, food group, and formulation. This paper aimed to compare the convergence points for food classification according to the FBDG and FST. This study was carried out in two phases. The first step was identifying the Food-Based Dietary Guidelines (FBDG). For each of the FBDG, food items were grouped as fruits, vegetables, cereals, sugars, fat and oils, legumes, foods from animals, dairy products, and others. The second step aimed to identify and describe the different food classification systems. The search was performed on PubMed®, Science Direct, and Web of Science and websites of international organizations such as the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO), and the Codex Alimentarius. Our results show that the points of convergence between the classifications were the classification in terms of origin (animal and vegetable), nutrient sources, and food groups. However, inconsistencies were observed for the distribution of food items in each group in the 98 surveyed FBDG. As for nature, there was a convergence for in natura, minimally processed, and processed foods. However, the criteria adopted for minimally processed and processed foods described in the FBDG differ from those considered by the FST. FST also does not recognize the classification of foods concerning the level of processing.

Associations of Sugar-Sweetened Beverages, Artificially Sweetened Beverages, and Pure Fruit Juice With Nonalcoholic Fatty Liver Disease: Cross-sectional and Longitudinal Study

OBJECTIVE

We aimed to test the associations of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), and pure fruit juice (PJ) consumption with the risk of nonalcoholic fatty liver disease (NAFLD).

METHODS

Data for 136 277 UK Biobank participants who completed the dietary questionnaire and did not have a history of liver disease were included. Logistic regression was used for the cross-sectional setting where NAFLD was defined by a fatty liver index (FLI) ≥60. Cox proportional hazard regression was used for the longitudinal setting where hospitalized NAFLD was defined as hospital admission with Internationl Classification of Diseases-10 codes K76.0 and K75.8.

RESULTS

Compared with 0 L/wk for corresponding beverages, multivariate-adjusted odds ratios (95% confidence intervals) for NAFLD in consumption ≤1, 1 to 2, and >2 L/wk were 1.06 (1.02-1.10), 1.24 (1.19-1.29), and 1.42 (1.35-1.49) for SSB; 1.43 (1.37-1.50), 1.73 (1.65-1.82), and 2.37 (2.25-2.50) for ASB, and 0.87 (0.84-0.89), 0.91 (0.88-0.94), and 1.07 (1.02-1.13) for PJ, respectively. Consumption of SSB and ASB were both positively correlated with FLI (P for line < .001). During a median follow-up of 10.2 years, 1043 cases of hospitalized NAFLD were recorded. ASB consumption of 1 to 2 and >2 L/wk was associated with a 22% (0.99-1.50) and 35% (1.11-1.65) increased risk of hospitalized NAFLD, respectively (P for trend = .002). However, the associations of SSB and PJ with the risk of hospitalized NAFLD were not significant.

CONCLUSIONS

Consumption of SSB, ASB, and PJ were all related to the risk of NAFLD. Excessive consumption of ASBs was associated with an increased risk of incident hospitalized NAFLD.

Effects and impacts of technical processing units on the nutrients and functional components of fruit and vegetable juice

Fruit and vegetable juice (FVJ) has become a favorite beverage for all age groups because of its excellent sensory and nutritional qualities. FVJ has a series of health benefits such as antioxidant, anti-obesity, anti-inflammatory, anti-microbial and anti-cancer. Except for raw materials selection, processing technology and packaging and storage also play a vital role in the nutrition and functional components of FVJ. This review systematically reviews the important research results on the relationship between FVJ processing and its nutrition and function in the past 10 years. Based on the brief elucidation of the nutrition and health benefits of FVJ and the unit operation involved in the production process, the influence of a series of key technology units, including pretreatment, clarification, homogenization, concentration, sterilization, drying, fermentation and packaging and storage, on the nutritional function of FVJ was systematically expounded. This contribution provides an update on the impacts of technical processing units on the nutrients and functional components of FVJ and new perspectives for future studies.

Use of a Water Filter at Home Reduces Sugary Drink Consumption among Parents and Infants/Toddlers in a Predominantly Hispanic Community: Results from the Water Up!@ Home Intervention Trial

BACKGROUND

Water is recommended as an alternative for sugar-sweetened beverages (SSBs). Low-income, minority groups in the United States continue to exhibit high SSB and low water consumption, and are more likely to exceed 100% fruit juice recommendations.

OBJECTIVE

To test the effects of a home-based intervention designed to replace SSBs with tap water and reduce excess juice consumption among parents and their infants/toddlers.

DESIGN

Randomized controlled trial.

PARTICIPANTS

Parents (n = 92) of infants/toddlers who participated in three Early Head Start home-visiting programs that serve predominantly Hispanic, low-income communities during 2019-2021.

INTERVENTION

The 12-week intervention (Water Up!@Home) simultaneously addressed physical barriers to tap water consumption (via a water filter) and sociocultural barriers to replacing SSBs and juice with water (via a curriculum). Comparison group received a water filter only. We hypothesized that the intervention would lead to a reduction of 6 fl oz/d in SSB and juice consumption.

MAIN OUTCOMES

Parent-reported self and infant/toddler SSBs, water (filtered, tap, or bottled), and 100% fruit juice consumption.

STATISTICAL ANALYSES

Analysis of covariance to compare changes in consumption between experimental groups was performed. We also conducted t tests to assess changes within groups.

RESULTS

Participants in both groups reported significant reductions in SSBs from baseline (parents: intervention [-11.2 fl oz/d; P < 0.01]; comparison [-8.0 fl oz/d; P < 0.01]; children: intervention [-1.50 fl oz/d; P = 0.03]; comparison [-1.56 fl oz/d; P = 0.02]), increased water consumption (parents in both groups [+5.6 fl oz/d]; children: intervention [+3.61 fl oz/d; P = 0.01], comparison [+2.24 fl oz/d; P = 0.05]), mostly from filtered tap water. Differences between groups were not statistically significant. Intervention participants reported significant reductions in 100% fruit juice vs comparison (parents: -3.6 fl oz/d vs -1.0 fl oz/d; P < 0.01; children: -0.73 fl oz/d vs +0.48 fl oz/d; P = .03).

CONCLUSIONS

The intervention effectively reduced 100% fruit juice consumption. Water security should be examined as a contributor to SSB consumption in this population.

Early feeding practices and body mass index z-score among Saudi preschoolers: a cross-sectional study

Background:

Feeding practices during early years may have long-lasting influences on eating behaviors, growth patterns and body mass index (BMI) trajectory. The objectives of this study were to characterize early feeding practices among mothers in Saudi Arabia and examine their associations with child birthweight and BMI z-score (BMIz) at preschool.

Methods:

This is a cross-sectional study including 209 mother-child dyads who were recruited from different preschools around the city of Jeddah, Saudi Arabia. Mothers completed the study questionnaire over the telephone and preschoolers’ anthropometric measurements were objectively measured using standardized procedures. Primary predictors included variables pertaining to breastfeeding initiation, breastfeeding duration, formula milk introduction, complementary feeding, and offering fruit juice, date syrup-milk mixture, and soda drinks in a baby bottle. The study’s primary outcome was BMIz at preschool. Mothers reported child’s birthweight and sociodemographic characteristics. Descriptive statistics were used to characterize early feeding practices. Bivariate analyses and linear regression analysis were used to examine the association of early feeding practices with child birthweight and BMIz at preschool.

Results:

About half of the mothers reported that they have offered fruit juice and/or date syrup-milk mixture in a baby bottle (52.2% and 45.9% respectively), with an average duration of 11.5 months (SD = 7.73) and 5.90 months (SD = 6.13), respectively. Children who were offered fruit juice and/or date syrup-milk mixture in a baby bottle had significantly lower birthweights compared to children who were not (M = 2.79, SD = 0.59 vs. M = 3.06, SD = 0.69, P < 0.01 and M = 2.79, SD = 0.67 vs. M = 3.03, SD = 0.62, P < 0.01, respectively). There was a negative association between introducing fruit juice in a baby bottle and child BMIz at preschool (β: -0.18, 95% confidence interval (CI): -0.83, -0.11); This association was not significant after adjusting for child birthweight and other covariates (β: -0.10, 95% CI: -0.64, 0.09).

Conclusion:

A large proportion of mothers reported offering fruit juice and date syrup-milk mixture in a baby bottle. Additional research is needed to understand associations with child birthweight and BMIz. Longitudinal and interventions studies can help inform counseling guidelines and community campaigns in order to improve early feeding practices in the region.

Beverage behaviors and correlates among Head Start preschooler-parent dyads

OBJECTIVES

To describe beverage behaviors among preschooler-parent dyads and explore correlates with preschooler's beverage behaviors.

METHODS

This exploratory, cross-sectional study includes a convenience sample of 202 parents of preschoolers surveyed from four Head Start programs in Virginia and Ohio. Measurements included parent-child beverage behaviors, parent beverage perceptions, parent beverage rules, home beverage availability, and demographics. Analyses included descriptive statistics, correlations, Kruskal-Wallis test, and Quade's non-parametric ANCOVA tests.

RESULTS

Mean sugar-sweetened beverage (SSB; i.e., regular soda, sweetened fruit drinks, sports/energy drinks, and coffee/tea with sugar) intake was 1.3 (SD = 1.4) and 2.3 (SD = 2.0) times/day for preschoolers and parents, respectively. When considering all sugary drink sources [i.e., summing SSB with flavored milk and 100% fruit juice (FJ)], the mean frequency increased to 3.2 (SD = 2.1) and 3.6 (SD = 2.4) times/day, respectively, for preschoolers and parents. A significant positive correlation was observed between preschooler-parent dyads for SSB (r = 0.406, p < 0.001) and for all sugary drinks (r = 0.572, p < 0.001). Parents who were younger, single, less educated, and with lower income had preschoolers with significantly higher SSB and all sugary drink intake (all p < 0.05). Significant correlates with preschoolers' beverage behaviors also included parent perceived behavioral control (SSB: p = 0.003, 100% FJ: p = 0.008, water: p < 0.0001), parenting practices (SSB: p = 0.022), and home availability (SSB: p = 0.011, 100% FJ: p < 0.001, water: p < 0.001).

CONCLUSIONS

This study highlights excessive SSB and all sugary drink consumption among Head Start preschooler-parent dyads. Also, intervention targets to improve preschooler's beverage behaviors are identified, including efforts to improve parent's beverage behaviors, perceived behavioral control, parenting practices, and the home environment.

The Relationship between Fluid Milk, Water, and 100% Juice and Health Outcomes among Children and Adolescents

Beverages can provide improved nutrient intake and hydration, but also pose concerns related to overnutrition or contamination for children and adolescents who are in a time of critical growth. This narrative review aims to understand the impact of milk, 100% juice, and water consumption on health-related outcomes in youth. The literature review conducted used PubMed, Web of Science, and CABI global. Forty-five research articles met the quality criteria and were included. Health organization and governmental resources were also reviewed to identify current intake and consumption recommendations. All beverages in this review were associated with a variety of desirable and undesirable findings that spanned over 40 different health outcomes. Most studies that assessed milk lacked clear distinction between milk type (flavored vs. unflavored) or fat percentage, making it difficult to understand the impact of milk consumption. The relationship between milk intake and anthropometric-related outcomes were mixed within and across studies. Water was consistently associated with better hydration, while 100% juice and flavored milk intake was associated with more desirable dietary patterns or nutrients that children are currently not consuming adequate amounts of. The implications of these findings were discussed in the context of the National School Lunch Program (NSLP), while considering the impact of issues such as contaminated water and lactose intolerance. This review suggests that water may be an optimal default beverage option in the NSLP to promote hydration and accommodate beverage preferences for those with lactose intolerance.

Intakes of nutrients and food categories in Canadian children and adolescents across levels of sugars intake: cross-sectional analyses of the Canadian Community Health Survey 2015 Public Use Microdata File

Dietary recommendations to reduce sugars consumption may influence choices of sugars-containing foods and affect the intake of key micronutrients. We compared intakes of nutrients and food sources stratified by quintiles of total sugars in Canadian children (2-8 y) and adolescents (9-13 y, 14-18 y) using 24-hour dietary recalls from the 2015 Canadian Community Health Survey-Nutrition. Energy intakes did not differ across quintiles of sugars intake. Those with lower sugars intakes (Q1/Q3) generally had higher protein, fat, sodium, niacin, folate, and zinc and lower vitamin C compared with those with the highest sugars intakes (Q5). Q1 also had lower potassium but higher saturated fat compared with Q5. Further, Q1 generally had higher protein, fats, and niacin compared with Q3, while children in Q3 had higher potassium and riboflavin and older adolescents had higher calcium and fibre. Q5 had highest intakes of multiple sugar-containing food categories (e.g., fruit, confectionary, milks, cakes/pies/pastries), with higher sugars-sweetened beverages in adolescents. Q3 had higher fruit, milks, and fruit juice compared with Q1 and lower sugars/syrups/preserves, confectionary, and fruit juices compared with Q5. Certain nutrient-dense food sources of sugars (fruit, milks) may help increase key nutrients (potassium, calcium, fibre) in older adolescents with low sugars intakes. However, in those with the highest sugars intakes, nutrient-poor foods may displace nutrient-dense foods. Novelty: Canadian children and adolescents with lower sugars intake have better intakes of some nutrients. Energy intakes did not differ across sugars intake. Older adolescents with mean intakes of total sugars had better intakes of some key nutrients (potassium, calcium, fibre).

Fruit juice and childhood obesity: a review of epidemiologic studies

Childhood obesity is a national epidemic, and many efforts have been made to understand its risk factors. The purpose of this review was to provide an updated account of the observational studies evaluating the relationship between 100% fruit juice intake and obesity in children and adolescents, and to highlight the major risk factors that may impact this relationship. PubMed and Scopus were searched for terms related to fruit juice and childhood obesity, and studies assessing 100% fruit juice intake in participants ≤ 19 years old, with obesity-related outcomes (BMI or adiposity), and published before March 9, 2021 were included. There were 17 prospective cohort and 14 cross-sectional studies included in the analysis. Overall, the evidence does not support a relationship between 100% fruit juice intake and measures of obesity in most children. There is some evidence to suggest a minor positive association in some overweight or very young children, but due to fundamental differences and limitations in methodology, further investigation is required. Significant gaps in literature on this topic exist particularly in regards to randomized clinical trials in children, and in studies in racially diverse populations.

Fruit Pouch Consumption and Dietary Patterns Related to BMIz at 18 Months of Age

Concerns have been raised that an overconsumption of baby food fruit pouches among toddlers might increase the risk of childhood obesity. This study aimed to quantify the consumption of fruit pouches and other fruit containing food products and to explore potential correlations between the consumption of these products and body-mass index z-score (BMIz) at 18 months, taking other predictive factors into consideration. The study was based on 1499 children and one-month-recall food frequency questionnaires from the Swedish population-based birth cohort NorthPop. Anthropometric outcome data were retrieved from child health care records. BMIz at 18 months of age was correlated to maternal BMI and gestational weight gain and inversely correlated to fruit juice consumption and breastfeeding. BMIz at 18 months of age was not correlated to consumption of fruit pouches, sugar-sweetened beverages, whole fruit or milk cereal drink. Overweight at 18 months of age was correlated to maternal BMI and inversely correlated to breastfeeding duration. To our knowledge, this is the first study that investigates possible associations between baby food fruit pouch consumption and overweight in toddlers. We found that moderate fruit pouch consumption is not associated with excess weight at 18 months of age.

Fruit Juices: Are They Helpful or Harmful? An Evidence Review

Dietary guidelines often deal with 100% fruit juice (FJ) inconsistently because it represents a source of free sugars. However, FJ also provides bioavailable micronutrients and plant bioactives at levels similar to those found in whole fruits. The present review weighs up the evidence from high-quality studies investigating a potential health harm for FJ against evidence from studies which indicate a potential health benefit. The findings reveal that FJ consumption, at moderate intakes consistent with the dietary guidelines for the US and some European countries (75-224 mL daily), does not increase the risk of obesity, type 2 diabetes, cardiovascular disease or poor glycaemic control. In contrast, regular consumption of FJ-even up to 500 mL per day in short-to-medium-term studies-appears to confer a health benefit in terms of vascular function and reduced blood pressure. Emerging evidence for cognitive health benefits requires further investigation in human trials. Observational studies report associations between FJ and nutrient adequacy and suggest that FJ consumption is associated with reduced risk of stroke. In conclusion, FJ appears to offer more benefit than risk and there appears to be no justification for discouraging FJ within a balanced diet for children and adults.

Association of infant diet with subsequent obesity at 2-5 years among children exposed to gestational diabetes: the SWIFT study

AIMS/HYPOTHESES

This longitudinal analysis evaluated the independent and joint associations of any breastfeeding (BF) or exclusive BF (EBF) and intake of sugar-sweetened beverages (SSBs) and 100% fruit juice from birth to 1 year with subsequent overweight and obesity among young children exposed to gestational diabetes (GDM).

METHODS

The analysis utilised prospectively collected data from participants enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes after GDM (SWIFT); 1035 pregnant women (20-45 years) diagnosed with GDM, of whom 75% were of Black, Hispanic or Asian race and ethnicity. Mother-infant dyad characteristics and infant dietary intake were assessed via research protocols at in-person examinations, telephone interviews and monthly mailed surveys from birth to 1 year. Child weight, length and height were obtained from electronic health records at birth (2008-2011) and ages 2-5 years (2010-2016) to classify BMI percentile groups (n = 835).

RESULTS

Adequate BF (≥6 months), adequate EBF duration (≥6 months), and SSB and 100% fruit juice intake in the first year were independently associated with child obesity at ages 2-5 years (all p < 0.05). Compared with children with adequate EBF and no intake of SSB or 100% fruit juice, those with adequate EBF and intake of 100% fruit juice and/or SSBs had a four- to fivefold higher odds of obesity (aOR 4.2, 95% CI:1.6, 11.2 for 100% fruit juice; aOR 4.5, 95% CI:1.4, 8.5 for fruit juice or SSBs; and aOR 4.7, 95% CI:1.4, 15 for SSBs; all p < 0.01), while those with inadequate EBF (<6 months) and intake of 100% fruit juice and/or SSBs had a six- to 12-fold higher odds of obesity (aOR 6.4, 95% CI:2.4, 17.2 for fruit juice; aOR 6.6, 95% CI:2.7, 14.8 for fruit juice or SSBs; and aOR 12.2, 95% CI:4.3, 25 for SSBs; all p < 0.001). Compared with children with adequate BF and no intake of SSB or 100% fruit juice, those with adequate BF and intake of 100% fruit juice and/or SSBs had a threefold higher odds of obesity (aOR 3.1, 95% CI:1.1, 7.3 for fruit juice; aOR 3.3, 95% CI:1.3, 8.3 for fruit juice or SSBs; and aOR 3.4, 95% CI:1.3, 8.5 for SSBs; all p < 0.05), while those with inadequate BF (<6 months) and intake of 100% fruit juice and/or SSB were associated with five- to tenfold higher odds of obesity (aOR 4.8, 95% CI:2.3, 12.2 for fruit juice; aOR 6.0, 95% CI:2.5, 12.8 for fruit juice or SSBs; aOR 9.5, 95% CI:3.7, 15.1 for SSBs; all p < 0.05).

CONCLUSIONS/INTERPRETATION

This is the first study to prospectively evaluate the relation of BF or EBF duration and intake of SSB and 100% fruit juice during the first year of life with subsequent obesity in children exposed to GDM. Adequate BF or EBF combined with avoidance of SSB and 100% fruit juice during early infancy may ameliorate future child obesity in this high-risk population.

Role of Dietary Factors, Food Habits, and Lifestyle in Childhood Obesity Development: A Position Paper From the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition

ABSTRACT

Childhood obesity has high societal and economic impact but current treatment approaches are sub-optimal. In the last decade, important studies have been conducted aiming to identify strategies to prevent obesity during critical periods of life. Updated recommendations for childhood obesity prevention are needed. We present data from systematic reviews and meta- analysis, randomised controlled trials (RCTs) and large observational studies, published from 2011 onwards that consider the possible role of the following factors in obesity development: breast-feeding; macronutrient composition and method of complementary feeding; parenting style; dietary patterns; sugar-sweetened beverage consumption; eating behaviour (eg, skipping breakfast, family dinners. etc); meal frequency and composition (fast foods, snacking), portion size; dietary modulators of gut microbiota (including pre-, pro-, and synbiotics); physical activity and sedentary behaviour. We used the Medline database and the Cochrane Library to search for relevant publications. Important research gaps were also identified. This position paper provides recommendations on dietary factors, food habits, and lifestyle to prevent childhood obesity development, based on the available literature and expert opinion. Clinical research and high-quality trials are urgently needed to resolve numerous areas of uncertainty.

Youth Beverage Intake and Reported Prediabetes: Choice and Frequency Matter

INTRODUCTION

Sugar sweetened beverage (SSB) consumption among U.S. adolescents exceeds current recommendations. This study examines relationships between SSB intake and reported prediabetes.

METHOD

Data are from the 2019 Minnesota Student Survey (N = 125,375). Logistic regression was used to examine relationships between frequencies for SSB intake and youth reported prediabetes in analytic models adjusting for demographic and other cardiometabolic indicators. Additional analyses examined relationships between consumption of fruit juice, milk, and water, and prediabetes.

RESULTS

One in four youth reported consumption of at least one SSB daily. In fully adjusted models, a range of SSB intake frequencies were significantly associated with increased odds of reported prediabetes. All intake frequencies for water were associated with reduced odds of prediabetes.

DISCUSSION

Efforts to reduce SSB intake among adolescents are warranted to support cardiometabolic health. Study findings are consistent with current guidance identifying water as the preferred drink for adolescents' hydration needs.

Extracurricular Sports Participation and Sedentary Behavior in Association with Dietary Habits and Obesity Risk in Children and Adolescents and the Role of Family Structure: a Literature Review

PURPOSE OF REVIEW

Childhood obesity is considered a major problem in the modern world, associated with many health issues in youth. This review aimed the association between extracurricular sports participation, sedentary time/screen time, and "obesogenic" and "non-obesogenic" dietary habits among youth and to explore the role of family structure on the adoption of sedentary behaviors by children.

RECENT FINDINGS

Increased participation in extracurricular sports was associated with a healthier dietary pattern, containing more "non-obesogenic" food choices. Opposite results were indicated by sedentary activities. Increased time in watching TV, computer/electronic games, and other screen devices was positively associated with unhealthy dietary patterns. Overall, extracurricular activities influence the quality of food choices, which may prevent or promote childhood obesity; thus, sport-related activities should be promoted through public health policies. The role of the family structure is contradictory.

How Does the Probability of Purchasing Moderately Sugary Beverages and 100% Fruit Juice Vary Across Sugar Tax Structures?

OBJECTIVE

Sugar-sweetened beverage taxes are increasingly used to discourage sugar intake; however, the impact on consumer preferences for particular products is largely unknown. This study explored the impact of two tax structures (tiered vs. nontiered and inclusive vs. exclusive of 100% fruit juice) on participants' probability of purchasing moderately sugary beverages and 100% fruit juice.

METHODS

A sample of 3,584 Canadians aged 13 years and older completed a series of beverage purchasing tasks, each corresponding to a different tax condition, within an experimental marketplace. Tax conditions included a no-tax control, plus four taxes varying by structure (tiered vs. nontiered) and whether or not 100% fruit juice was included.

RESULTS

The odds of purchasing a moderately sugary beverage were higher under tiered versus nontiered taxes. Purchases of higher sugar beverages differed little across tiered versus nontiered structures. Odds of purchasing 100% fruit juice were lower when these products were taxed versus not taxed.

CONCLUSIONS

Results suggest that two key tax structures are likely to function as expected; taxes including 100% fruit juice products may lead to lower probability of purchasing fruit juice, and taxes incorporating multiple tiers may be more likely to encourage purchases of moderately sugary products than nontiered formats.

Orange juice intake and anthropometric changes in children and adolescents

OBJECTIVE

Evaluate associations between orange juice (OJ) consumption and anthropometric parameters.

DESIGN

Prospective cohort study assessing the association between OJ intake and changes in BMI and height-for-age Z-score (HAZ) using mixed linear regression.

SETTING

2004-2008, USA.

PARTICIPANTS

Children from the Growing Up Today Study II (n 7301), aged 9-16 years at enrollment.

RESULTS

OJ consumption was positively associated with 2-year change in HAZ in girls (mean (se)): 0·03 (0·01) for non-consumers, 0·03 (0·02) for 1-3 glasses/month, 0·06 (0·01) for 1-6 glasses/week and 0·09 (0·02) for ≥1 glass/d after full adjustment (Ptrend = 0·02). However, OJ consumption was not associated with 2-year change in BMI percentile (kg/m2, mean (se)): -0·44 (0·36) for non-consumers, 0·20 (0·41) for 1-3 glasses/month, -0·04 (0·34) for 1-6 glasses/week and -0·77 (0·62) for ≥1 glass/d in girls, Ptrend = 0·81; -0·94 (0·53) for non-consumers, -1·68 (0·52) for 1-3 glasses/month, -0·81 (0·38) for 1-6 glasses per week and -1·12 (0·61) for ≥1 glass/d in boys, Ptrend = 0·49.

CONCLUSION

OJ consumption was favourably associated with height growth but unrelated to excess weight gain. OJ may be a useful alternative to whole fruit in the event that whole fruit intake is insufficient.

Consumption of 100% Orange Juice in Relation to Flavonoid Intakes and Diet Quality Among US Children and Adults: Analyses of NHANES 2013-16 Data

This study explored consumption patterns of 100% orange juice by socio-demographics among US children and adults. Dietary intakes data for 15,983 persons aged >2 y came from the nationally representative National Health and Nutrition Examination Survey (NHANES 2013-2016). The What We Eat in America nutrient composition database was merged with the USDA Expanded Flavonoid Database to assess flavonoid intakes. Diet quality measures were the Healthy Eating Index (HEI-2015) and Nutrient Rich Food (NRF9.3) Index. Orange juice consumption accounted for a mean of 14 kcal/d and varied with age, incomes, and race/ethnicity. Orange juice consumption was associated with higher intakes of bioactive flavonoids, lower added sugars, and higher-quality diets overall. Diets of consumers were higher in vitamin C, potassium, calcium, vitamin D (adults), flavanones, and total flavonoids (children) as compared to non-consumers. Consumers had significantly higher HEI-2015 and NRF9.3 scores and lower body mass index values (adults). However, only 15.9% of the NHANES sample consumed any orange juice at all; of these 11.8% had <1 serving/day and only 3.4% had 1 serving/day or more.

A longitudinal study of fruit juice consumption during preschool years and subsequent diet quality and BMI

Background

The role of fruit juice in pediatric dietary guidelines continues to be controversial, particularly with respect to concerns about unhealthy dietary habits and the potential promotion of excessive weight gain. The objective of the current study was to determine the association between preschool fruit juice consumption and the following outcomes during childhood and adolescence: whole and total fruit intake, diet quality, likelihood of meeting current dietary recommendations, and BMI change.

Methods

The data were previously collected from 100 children enrolled in the Framingham Children’s Study at 3–6 years of age and subsequently followed for 10 years. Dietary data were collected annually using multiple sets of 3-day diet records. Compliance with dietary recommendations was estimated based on 2015–2020 Dietary Guidelines for Americans and diet quality was measured using the associated Healthy Eating Index (HEI). Mixed linear and logistic regression models were used for statistical analyses.

Results

Preschool children (3–6 years) who drank ≥1.0 (vs. < 0.5) cup of 100% fruit juice/day consumed 0.9 cups/day more total fruit (p < 0.0001) and 0.5 cups/day more whole fruit (p < 0.0001) during adolescence (14–18 years). Total HEI scores during adolescence for those with the highest preschool juice intakes were almost 6 points higher than those with the lowest fruit juice intakes (p = 0.0044). Preschoolers consuming < 0.5 cups/day of fruit juice had sharply declining whole fruit intake throughout childhood compared with those preschoolers consuming ≥1.0 cups/day who had stable intakes of whole fruit throughout childhood. Those children who consumed ≥0.75 cups/day of fruit juice during preschool (vs. less) were 3.8 times as likely to meet Dietary Guidelines for whole fruit intake during adolescence (p < 0.05). Finally, in multivariable models, there was no association between fruit juice consumption and BMI change throughout childhood.

Conclusion

These data suggest that preschool consumption of 100% fruit juice is associated with beneficial effects on whole fruit intake and diet quality without having any adverse effect on BMI during childhood and into middle adolescence.

Consumption of Sugar-Sweetened Beverages, Juice, Artificially-Sweetened Soda and Bottled Water: An Australian Population Study

Reducing consumption of free sugars, such as those found in high concentrations in manufactured products such as sugar-sweetened beverages (SSBs) and 100% fruit juices, is a global public health priority. This study aimed to measure prevalence of widely available pre-packaged non-alcoholic water-based beverages (carbonated sodas, sports drinks, energy drinks, artificially-sweetened sodas, fruit juices (any type), and bottled water) and to comprehensively examine behavioral, environmental, current health, and demographic correlates of consumption. A cross-sectional, nationally-representative population survey of 3430 Australian adults (18+ years) was conducted using computer-assisted telephone (mobile and landline) interviewing. Past week prevalence of pre-packaged drinks containing free sugar was 47.3%; daily prevalence was 13.6%. Of all the pre-packaged drinks assessed, consumption of fruit juices (any type) was the most prevalent (38.8%), followed by bottled water (37.4%), soda (28.9%), artificially-sweetened soda (18.1%), sports drinks (8.1%), and energy drinks (4.2%). Higher soda consumption was associated with males, younger age, socio-economic disadvantage, frequent takeaway food consumption, availability of soda in the home, obesity, and a diagnosis of heart disease or depression. A diagnosis of Type 2 Diabetes was associated with increased likelihood of consuming artificially-sweetened sodas and decreased likelihood of consuming sugar-sweetened soda. SSB consumption is prevalent in Australia, especially among young adults and males, foreshadowing continued population weight gain and high burdens of chronic disease. To reduce consumption, Australia must take a comprehensive approach, incorporating policy reform, effective community education, and active promotion of water.

Quick and Cost-Effective Estimation of Vitamin C in Multifruit Juices using Voltammetric Methods

Ascorbic Acid (AA) is a natural and powerful water-soluble antioxidant associated with long-lasting food products. As time passes, the AA content in products sharply decreases, and they become increasingly degraded. There are several techniques to precisely quantify AA concentrations. However, most of them employ costly laboratory instruments, such as High-Performance Liquid Chromatography (HPLC) or complex electrochemical methods, which make unfeasible recurrent AA measurements along the entire supply chain. To address this issue, we contribute with an in-field and real-time voltammetric method, carried out with a low-cost, easy-to-use, and portable device. An unmodified Screen-Printed Electrode (SPE) is used together with the device to achieve short reading times. Our method has been extensively tested in two multifruit juices using three different SPEs. Calibration curves and Limit of Detection were derived for each SPE. Furthermore, periodic experiments were conducted to study the shelf life of juices under consideration. During the analysis, a set of assays for each SPE were implemented to determine the remaining AA amount per juice and compare it with that obtained using HPLC under the same conditions. Results revealed that our cost-effective device is fully comparable to the HPLC equipment, as long as the juice does not include certain interferents; a scenario also contemplated in this article.

Associations between 100% Orange Juice Consumption and Dietary, Lifestyle and Anthropometric Characteristics in a Cross-Sectional Study of U.S. Children and Adolescents

Concerns about orange juice’s sugar content have spurred discussions regarding its potential contributions to childhood obesity. The objective of this study was to evaluate the association between 100% orange juice (OJ) consumption and dietary, lifestyle and anthropometric characteristics in children and adolescents. Baseline anthropometric, dietary and lifestyle data from the Growing Up Today Study I (GUTS I) and GUTS II were collected via self-reported questionnaires from 26,554 participants. The mean values of these variables were then computed for children grouped by categories of OJ consumption, and linear trend testing was used to determine whether OJ consumption was linearly related to these variables. Multivariate adjustment modeling was used to calculate odds ratios of being obese or overweight/obese by OJ consumption. Among both boys and girls, OJ intake was positively associated with height, height-for-age z-score (HAZ), intakes of total energy, total energy excluding OJ, fruits and non-starchy vegetables and physical activity. BMI, BMI z-score and BMI-for-age percentile did not differ by OJ consumption. After adjustment for cohort, age, race, total energy intake without OJ, physical activity and screen time, prevalence of overweight/obesity significantly decreased by OJ intake in boys compared to non-consumers (odds ratio (OR) and 95% confidence interval (CI)): 1.17 (1.02, 1.33) for 1–3 glasses per month, 1.11 (0.98, 1.26) for 1–6 glasses per week, 1.00 (0.85, 1.18) for 1 glass per day, 0.91 (0.73, 1.13) for ≥1 glass per day, p-trend = 0.0403). Prevalence of obesity similarly decreased by OJ intake in boys. Prevalence of overweight/obesity and obesity did not significantly differ by OJ intake in girls. The results indicate that children consuming more OJ tended to practice healthier dietary and lifestyle habits without increased prevalence or odds of obesity or overweight.

Intake of 100% Fruit Juice Is Associated with Improved Diet Quality of Adults: NHANES 2013-2016 Analysis

Fruit intake is generally associated with better diet quality and overall health. This report examined the effect of 100% fruit juice (considered a part of total fruit servings) and its replacement with whole fruits equivalents on nutrient intake and diet quality. National Health and Nutrition Examination Survey 2013-2016 data (24-h dietary recall) from adults 19+ years (n = 10,112) were used to assess the diet quality and nutrient intakes and to isocalorically replace with 100% fruit juice intakes whole fruit equivalents in a modeling analysis. About 15.6% adults were 100% fruit juice consumers. Consumers had higher diet quality (10% higher Healthy Eating Index, HEI 2015 score), and higher intakes of energy, calcium, magnesium, potassium, vitamin C and vitamin D than non-consumers. Consumption of 100% fruit juice was also associated with lower risk of being overweight/obese (-22%) and having metabolic syndrome (-27%). Replacing 100% fruit juice with whole fruits equivalents did not affect nutrient intake except for a modest increase (+6.4%) in dietary fiber. Results show that 100% fruit juice intake was associated with better diet quality and higher nutrient intake. Replacement of 100% fruit juice intake with whole fruits equivalents had no significant effect on nutrients except for dietary fiber.

Consumption Patterns of Milk and 100% Juice in Relation to Diet Quality and Body Weight Among United States Children: Analyses of NHANES 2011-16 Data

Background: The American Academy of Pediatrics (AAP) has recommended placing limits on the consumption of milk and 100% juice by children. Methods: Consumption data for 9,069 children aged 2-19 years came from three cycles of the nationally representative National Health and Nutrition Examination Survey (NHANES 2011-2016). Beverages were classified into 100% juices, milk (whole, reduced fat, and skim), caloric sugar sweetened beverages (SSB), low calorie beverages (LCB), and drinking water. The Healthy Eating Index 2015 and Nutrient Rich Food Index NRF9.3 were two measures of diet quality. Analyses examined consumption patterns for milk and 100% juice in relation to diet quality, AAP recommendations, and BMI z-scores across time and for different age groups. Results: Intakes of milk and 100% juice declined sharply with age, whereas SSB and water increased. Top quartiles of HEI 2015 and NRF9.3 diet quality scores were associated with higher intakes of water, milk, and 100% juice and with lower intakes of SSB. Lower-income groups drank less skim milk and water and more whole milk and SSB. Only 30% of the children consumed any 100% juice. There was no association between the consumption of milk or 100% juice and BMI z-scores for any age group. Conclusions: Top quartiles of diet quality were associated with more milk, 100% juice, and water, and less SSB. Higher quality diets were associated with lower compliance with the AAP 100% juice recommendations. Compliance with the AAP 100% juice recommendations was not associated with lower body weights. Attempts to limit the consumption of milk and 100% juice by children might have the unintended consequence of increasing consumption of SSB and may have limited value for obesity prevention.

100% Fruit Juice in Child and Adolescent Dietary Patterns

Objective: Nutritional advice based on strengthening the dietary pattern offers a very different perspective from the reductionist practice of reporting risks or benefits for individual foods.Methods: A healthful dietary pattern can be composed of innumerable different combinations of foods and beverages that collectively and synergistically protect health. Although pure juices lack fiber, juicing retains the majority of health-promoting nutrients and phytochemicals of the whole fruit. Bioactive components of 100% fruit juice have demonstrated positive clinical effects on oxidative markers, inflammation, endothelial reactivity, lipid profiles, hypertension, and platelet aggregation. Fruit juice consumers have higher scores for diet quality. They consume more whole fruit, less added sugar, and greater amounts of vitamin C, magnesium, potassium, and fiber-containing foods than non-consumers.Results: Concerns that 100% fruit juice may be associated with childhood weight gain or metabolic consequences have not been supported by recent systematic reviews and meta-analyses. Juice consumption may be particularly important for the diet quality of lower-socioeconomic-status populations. Over the past 3 decades, as fruit juice intake has fallen substantially, the vacuum has not been filled by a comparable increase in servings of whole fruit, keeping Americans from meeting daily fruit recommendations.Conclusions: Counseling about individual foods without considering their impact on overall diet quality may harm the dietary pattern without discernible health benefits.

Drink Choice is Important: Beverages Make a Substantial Contribution to Energy, Sugar, Calcium and Vitamin C Intake among Australians

It is important to understand the role of beverages in population dietary intake in order to give relevant advice. Population estimates were derived from one-day food recall dietary data from 12,153 participants in the 2011–2012 Australian National Nutrition and Physical Activity Survey. Almost all Australians (99.9%) consumed at least one beverage on the day of the survey, accounting for 16.6% of the total energy intake for adults (aged 19 years and over) and 13.0% for children (aged 2–18 years). Similarly, beverages contributed 26–29% to calcium intake, 22–28% to vitamin C intake, and 35–36% to sugar intake. Water was consumed on the day of the survey by 84.1% of Australian adults and 90.5% of children. For adults, the greatest beverage contributors to total energy intake were alcoholic drinks (5.6%), coffee (3.1%), and soft drinks (1.9%), and for children, plain milk (3.1%), flavoured milk (2.8%), and fruit juice (2.6%). Coffee (10.6%) made the greatest contribution to calcium intake for adults; and plain milk (9.9%) and flavoured milk (7.6%) for children. The greatest contributors to vitamin C intake were fruit juice (13.4%) and alcoholic drinks (6.1%) for adults; and fruit juice (23.4%) for children. For total sugar intake, soft drinks (8.0%), coffee (8.4%), and fruit juice (5.9%) made the highest contribution for adults; and fruit juice (9.8%) and soft drinks (8.7%) for children. The type and amount of beverage consumption has considerable relevance to dietary quality for Australians.

Beverage Intake and Its Effect on Body Weight Status among WIC Preschool-Age Children

Given the prevalence and consequences of childhood obesity, efforts are being made to identify risk factors and design evidence-based interventions to reduce its impact. Food and beverage consumption habits are established early in life, making preschool-age children an important group to focus on. This cross-sectional study explored beverage intake and its association with body weight status among low-income preschool-age children enrolled in the Special Supplementation Nutrition Program for Women, Infants, and Children (WIC). Authorized representatives for children between the ages of 3 and 4.9 years were interviewed at WIC clinics in Broward County, Florida. Anthropometric data were collected from the WIC data system. The intake of sugar-sweetened beverages (SSB), particularly fruit drinks, was significantly higher in overweight/obese children when compared with their under/normal weight counterparts. Independent of body weight status, the preschool-age children were consuming on average over twice as much as the recommended intake of 100% fruit juice per day for that age group. Close to 80% of the overweight/obese children consumed low-fat or fat-free milk most often than any other type of milk. The intake of SSB was positively correlated with both the intakes of 100% fruit juice and milk, and negatively correlated with the intake of water. When body weight status, race/ethnicity, and intake of other beverages were held constant, SSB intake was positively associated with milk intake and negatively associated with water intake. Results from this study support the need to encourage water intake and discourage SSB intake in an effort to reduce the risk for overweight and obesity in WIC-participating preschool-age children. Emphasizing the need to follow the recommendation to limit 100% fruit juice intake to 4 to 6 oz. per day is important when counseling families with young children. Efforts to increase awareness of the health consequences associated with consuming high-fat milk should continue.

Pure fruit juice and fruit consumption and the risk of CVD: the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study

Dietary guidelines for pure fruit juice consumption differ between countries, regarding the question whether pure fruit juice is an acceptable alternative for fruit. Currently, little is known about pure fruit juice consumption and the risk of CVD. In this prospective cohort study, we studied the association of pure fruit juice and fruit consumption with the incidence of fatal and non-fatal CVD, CHD and stroke and investigated the differences in association with pure fruit juice consumption between low and high fruit consumers. A validated FFQ was used to estimate dietary intake of 34 560 participants (26·0 % men and 74·0 % women) aged 20–69 years from the European Prospective Investigation into Cancer and Nutrition–Netherlands study. Adjusted hazard ratios (HR) were estimated using Cox regression after average follow-up of 14·6 years. Compared with no consumption, pure fruit juice consumption up to 7 glasses/week – but not consumption of ≥8 glasses – was significantly associated with reduced risk of CVD and CHD, with HR from 0·83 (95 % CI 0·73, 0·95) to 0·88 (95 % CI 0·80, 0·97). Consumption of 1–4 and 4–8 glasses/week was significantly associated with lower risk of stroke with HR of 0·80 (95 % CI 0·64, 0·99) and 0·76 (95 % CI 0·61, 0·94), respectively. Associations did not differ considerably between low and high fruit consumers. The highest three quintiles of fruit consumption (≥121 g/d) were significantly associated with lower incidence of CVD, with HR of 0·87 (95 % CI 0·78, 0·97) and 0·88 (95 % CI 0·80, 0·98). In conclusion, although we observed favourable associations of moderate pure fruit juice consumption with CVD, for now consumption of whole fruit should be preferred because the evidence of the health benefits of fruit is more conclusive.

Food Sources of Energy and Nutrients of Public Health Concern and Nutrients to Limit with a Focus on Milk and other Dairy Foods in Children 2 to 18 Years of Age: National Health and Nutrition Examination Survey, 2011⁻2014

Many children are not meeting current nutrient recommendations. The objective of this study was to determine the food sources of energy, nutrients of public health concern, and nutrients to limit with a focus on dairy foods. Twenty-four-hour dietary recall data from children 2–5 (n = 1511), 6–11 (n = 2193), and 12–18 years (n = 2172) participating in NHANES 2011–2014 were analyzed. Energy, fiber, calcium, potassium, vitamin D, added sugars, saturated fatty acids (SFA), and sodium intakes were sample-weighted and ranked on percentage contribution to the diet using specific food group intake and disaggregated data for dairy foods. For children 2–5, 6–11, and 12–18 years, milk, sweet bakery products, and sweetened beverages, respectively were the top food sources of energy, respectively. For calcium, potassium, and vitamin D, milk was the top ranked food source in all age groups. For children 2–5, 6–11, and 12–18 years, milk, sweet bakery products, and pizza, respectively were the top three ranked food sources of SFA; and sugar sweetened beverages and sweet bakery products were to top two food group sources of added sugars. Cured meats/poultry, pizza, and pizza, respectively, were the top ranked food sources of sodium for the three age groups. Identification of food sources of these nutrients can help health professionals implement appropriate dietary recommendations and plan age-appropriate interventions.

Protocol for the scientific opinion on the Tolerable Upper Intake Level of dietary sugars

In June 2016, EFSA received a mandate from the national food competent authorities of five European countries (Denmark, Finland, Iceland, Norway and Sweden) to provide a dietary reference value (DRV) for sugars, with particular attention to added sugars. A draft protocol was developed with the aim of defining as much as possible beforehand the strategy that will be applied for collecting data, appraising the relevant evidence, and analysing and integrating the evidence in order to draw conclusions that will form the basis for the Scientific Opinion on sugars. As EFSA wished to seek advice from stakeholders on this draft protocol, the NDA Panel endorsed it for public consultation on 12 December 2017. The consultation was open from 9 January to 4 March 2018. A technical meeting with stakeholders was held in Brussels on 13 February 2018, during the consultation period. After consultation with stakeholders and the mandate requestors, EFSA interprets this mandate as a request to provide scientific advice on an Tolerable Upper Intake Level (UL) for (total/added/free) sugars, i.e. the maximum level of total chronic daily intake of sugars (from all sources) judged to be unlikely to pose a risk of adverse health effects to humans. The assessment concerns the main types of sugars (mono- and disaccharides) found in mixed diets (i.e. glucose, fructose, galactose, sucrose, lactose, maltose and trehalose) taken through the oral route. The health outcomes of interest relate to the development of metabolic diseases and dental caries. The final version of the protocol was endorsed by the EFSA Panel on Dietetic Products, Nutrition and Allergies on 28 June 2018.

Consumption of 100% Pure Fruit Juice and Dietary Quality in French Adults: Analysis of a Nationally Representative Survey in the Context of the WHO Recommended Limitation of Free Sugars

Sugar-containing beverages are often seen as a negative influence on diet quality and body weight control. The present study examines the consumption of 100% fruit juice (FJ) based on a seven-day dietary survey in a representative sample of French adults (n = 1607). About a half of the participants (44%) consumed FJ, most often at breakfast time (60%). Average intake in FJ consumers was 115.6 ± 4.0 mL/day (46.3 ± 1.7 kcal/day). Prevalence of consumption increased with education and income and decreased with age, but no association was observed with body mass index (BMI), physical activity, or smoking. In consumers, FJ brought 2% daily energy and contributed larger proportions of vitamins (B1 7%, B2 3%, B5 5%, B6 6%, B9 10%, C 32%, E 9%, beta-carotene 5%), minerals (magnesium 4%, potassium 7%), and free sugars (19%). FJ consumers ingested more whole fruits, vegetables, and many other foods than non-consumers did. Free sugars represented 11.2% of the daily energy in FJ consumers versus 8.6% in non-consumers. This cross-sectional survey reveals that FJ contributes to diet quality without association with excess body weight. These observations should be confirmed in longitudinal studies. They support the view that contribution to diet quality should be specifically recognized in the context of the World Health Organization (WHO) recommended decrease of free sugar intake.

Review of 100% Fruit Juice and Chronic Health Conditions: Implications for Sugar-Sweetened Beverage Policy

Whether or not drinking 100% fruit juice causes poor health is controversial. Although 100% fruit juice may contain as much sugar as regular soda, it provides needed nutrients to Americans' diets. We systematically reviewed the current evidence of the association of 100% fruit juice consumption and chronic health conditions in children and adults. We focused on data from systematic reviews and meta-analyses about cardiometabolic health outcomes, liver disease, and caries. Aside from increased risk of tooth decay in children and small amounts of weight gain in young children and adults, there is no conclusive evidence that consumption of 100% fruit juice has adverse health effects. Guidelines from groups like the American Academy of Pediatrics and Dietary Guidelines for Americans recommending that 100% fruit juice may be consumed in moderation are consistent with the available evidence and should be used to inform food policies.

Perspective: Total, Added, or Free? What Kind of Sugars Should We Be Talking About?

There is consistent public guidance to limit sugars intakes. However, WHO recommendations are for "free" sugars, whereas some other guidance documents and public discussion focus on "added" sugars, and globally most food labeling states "total" sugars. Total sugars comprise all mono- and disaccharides, regardless of source, whereas both added and free sugars exclude the sugars that naturally occur in dairy products and intact fruit and vegetables. Definitions of added and free sugars differ mainly in their respective exclusion or inclusion of sugars in juiced or pureed fruit and vegetables. To date, there has been little evidence-based analysis of the scientific basis for these different sugar classifications or implications of their adoption for consumer communication and nutrition labeling. Evidence of discriminating relations of total compared with added or free sugars with weight gain or energy intake, type 2 diabetes, and dental caries was identified from recent systematic reviews and meta-analyses. The relations were weakest for total sugars and most consistent for dietary sources corresponding to free sugars (including sugars added to and in fruit juices). Consideration of these health outcomes suggests that the emphasis for intake monitoring, public health guidance, and consumer communication should be on free sugars. However, at present, the adoption of free sugars for these purposes would also carry challenges related to implementation, including consumer understanding, consensus on specifications, and current (labeling) regulations.

The SENS algorithm-a new nutrient profiling system for food labelling in Europe

BACKGROUND/OBJECTIVES

In response to the European regulation on nutrition and health claims, France proposed in 2008 the SAIN,LIM profiling system that classifies foods into four classes based on a nutrient density score called 'SAIN', a score of nutrients to limit called 'LIM', and one primary threshold on each score. We present here the SENS algorithm, a new nutrient profiling system adapted from the SAIN,LIM to be operational for simplified nutrition labelling in line with the European regulation on food information to consumers.

SUBJECTS/METHODS

The main changes made to SAIN,LIM to get SENS were to introduce food categories and sub-categories ('Beverages', 'Added Fats' and 'Other Solid Foods' sub-categorised into 'cereals', 'cheese', 'other dairy products', 'eggs', 'fish' and 'others'), reduce the number of nutrients, introduce category-specific nutrients and category-specific weighting for some nutrients, replace French recommendations with European reference intakes, and add secondary thresholds. Each food and non-alcoholic beverage from the 2013-CIQUAL French composition database (n = 1065) was assigned one SENS class. Distribution of foods according to the four SENS classes was described by food groups (n = 26).

RESULTS

The SENS classification was consistent with the recommendations to consume large amounts of whole grains, vegetables and fruits, and moderate intake of fats, sugars, meats, caloric beverages and salt. For most groups (19/26), foods were distributed across at least three SENS classes.

CONCLUSIONS

The SENS is a nutrition-sensitive system that discriminates foods between and within food categories. It preserves the strengths of the initial SAIN,LIM while making it operational for simplified nutrition labelling in Europe.

Satisfying America's Fruit Gap: Summary of an Expert Roundtable on the Role of 100% Fruit Juice

The 2015 to 2020 Dietary Guidelines for Americans (DGAs) recognize the role of 100% fruit juice in health and in helping people meet daily fruit recommendations and state that 100% fruit juice is a nutrient-dense beverage that should be a primary choice, along with water and low-fat/fat-free milk. The DGAs note that children are consuming 100% fruit juice within recommendations (that is, 120 to 180 mL/d for children aged 1 to 6 y and 236 to 355 mL/d for children aged 7 to 18 y). Evidence shows that compared to nonconsumers, those who consume 100% fruit juice come closer to meeting daily fruit needs and have better diet quality. In children, 100% fruit juice is associated with increased intakes of nutrients such as vitamin C, folate, and potassium. When consumed within the DGA recommendations, 100% fruit juice is not associated with overweight/obesity or childhood dental caries and does not compromise fiber intake. Preliminary data suggest that polyphenols in some 100% fruit juices may inhibit absorption of naturally occurring sugars. Given its role in promoting health and in helping people meet fruit needs, experts participating in a roundtable discussion agreed that there is no science-based reason to restrict access to 100% fruit juice in public health nutrition policy and programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Reducing or eliminating 100% fruit juice could lead to unintended consequences such as reduced daily fruit intake and increased consumption of less nutritious beverages (for example, sugar-sweetened beverages).

Fruit Juice and Change in BMI: A Meta-analysis

CONTEXT

Whether 100% fruit juice consumption causes weight gain in children remains controversial.

OBJECTIVE

To determine the association between 100% fruit juice consumption and change in BMI or BMI z score in children.

DATA SOURCES

PubMed, Embase, CINAHL, and Cochrane databases.

STUDY SELECTION

Longitudinal studies examining the association of 100% fruit juice and change in BMI measures were included.

DATA EXTRACTION

Two independent reviewers extracted data using a predesigned data collection form.

RESULTS

Of the 4657 articles screened, 8 prospective cohort studies (n = 34 470 individual children) met the inclusion criteria. Controlling for total energy intake, 1 daily 6- to 8-oz serving increment of 100% fruit juice was associated with a 0.003 (95% CI: 0.001 to 0.004) unit increase in BMI z score over 1 year in children of all ages (0% increase in BMI percentile). In children ages 1 to 6 years, 1 serving increment was associated with a 0.087 (95% confidence interval: 0.008 to 0.167) unit increase in BMI z score (4% increase in BMI percentile). 100% fruit juice consumption was not associated with BMI z score increase in children ages 7 to 18 years.

LIMITATIONS

All observational studies; studies differed in exposure assessment and covariate adjustment.

CONCLUSIONS

Consumption of 100% fruit juice is associated with a small amount of weight gain in children ages 1 to 6 years that is not clinically significant, and is not associated with weight gain in children ages 7 to 18 years. More studies are needed in children ages 1 to 6 years.

Beverage Consumption among U.S. Children Aged 0-24 Months: National Health and Nutrition Examination Survey (NHANES)

Data on beverage consumption patterns in early life are limited. The aim of this study was to describe beverage consumption by sociodemographic characteristics, along with water intake and sources of water among U.S. children aged 0-24 months. Data from 2740 children in the 2005-2012 NHANES were analysed. Food intake was determined via one 24-h dietary recall. Beverages were categorised according to What We Eat In America groups. Poverty-Income ratio was used to define household income. During infancy (0-5.9 months and 6-11.9 months) infant formulas were the most commonly consumed beverage, 74.1% and 78.6% of children consuming, respectively. Comparatively fewer children, 41.6% and 24.3%, consumed breast milk. In toddlers (12-24 months), the most commonly consumed beverages were plain milk (83.6% of children consuming), water (68.6%), 100% fruit juice (51.8%) and sweetened beverages (31.2%). Non-Hispanic black and Mexican-American children were more likely to consume sweetened beverages, 100% fruit juice and infant formula than Non-Hispanic white children. Children from lower income households were more likely to consume sweetened beverages and 100% fruit juice and less likely to consume breast milk than children from higher income households. Total water intake increased with age and the contribution of water from food and beverage sources was ~20% and ~80% for all children, respectively. Disparities in beverage consumption by race/ethnicity and income level are apparent in early life.

Beverages and snacks available in vending machines from a subset of Ontario secondary schools: Do offerings align with provincial nutrition standards?

OBJECTIVES

As part of an evaluation of Ontario's School Food and Beverage Policy (P/PM 150) in a populous Ontario region, this research aimed to: 1) identify, describe and categorize beverages and snacks available for purchase in secondary school vending machines according to P/PM 150 standards; and 2) compare the number and percentage of beverages and snacks within P/PM 150 categories (Sell Most, Sell Less, Not Permitted) from Time I (2012/2013) to Time II (2014).

METHODS

Representatives from consenting secondary schools assisted researchers in completing a Food Environmental Scan checklist in Times I and II. Sourced nutritional content information (calories, fats, sodium, sugars, ingredients and % daily values) was used to categorize products. The number and percentage of products in P/PM 150 categories were compared between Times by paired t-tests.

RESULTS

Of 26 secondary schools participating in total, 19 participated in both Time periods and were included in the study. There were 75 beverages identified (59 Time I, 45 Time II), mostly water, juices and milk-based beverages; and 132 types of snacks (87 Time I, 103 Time II), mostly grain-based snacks, vegetable/fruit chips, and baked goods. A majority of schools offered one or more Not Permitted beverages (47% Time I, 58% Time II) or snacks (74% Time I, 53% Time II). Significantly more schools met P/PM 150 standards for snacks (p = 0.02) but not beverages in Time II.

CONCLUSION

Full P/PM 150 compliance was achieved by few schools, indicating that schools, school boards, public health, and food services need to continue to collaborate to ensure nutrient-poor products are not sold to students in school settings.

Higher Diet Quality in Adolescence and Dietary Improvements Are Related to Less Weight Gain During the Transition From Adolescence to Adulthood

OBJECTIVES

To examine the previously validated A Priori Diet Quality Score (APDQS), and weight change among adolescents transitioning into young adulthood.

STUDY DESIGN

Young people were recruited in middle/high schools and followed for 10 years. Participants reported diet and weight in 1999 (mean age, 15 years), 2004 (20 years), and 2009 (25 years). The analytic sample (n = 2656) had dietary intake assessments in 1999 and at least one other assessment. The APDQS (without alcoholic items) was based on 13 beneficial food groups, 12 adverse food groups, and 9 neutral food groups to capture aspects of Mediterranean/prudent diets, focusing on foods that are varied, based on nutritionally rich plants, and less processed.

RESULTS

From mean age 15 to 25 years, mean (SD) weight increased from 61.0 (14.7) kg to 76.1 (18.8) kg, and APDQS increased from 43.1 (11.1) points to 45.6 (10.7) points. Within-person tracking correlation of the APDQS was 0.35 at mean age 15-20 years, increasing to 0.49 at 20-25 years. Independent of lifestyle factors and energy intake, a 15-point (IQR) higher APDQS in 1999 was associated with 1.5 kg (95% CI, 0.7-2.3 kg) less weight gain over 10 years, The increase in APDQS over time was similarly associated with less concurrent weight gain. Findings were stronger for models of excess weight gain.

CONCLUSION

Higher diet quality, based on an assessment of dietary patterns in and after adolescence, was associated with reduced weight gain during the next 10 years. Establishment of high-quality dietary patterns in adolescence may help mitigate excess weight gain by young adulthood.

Predictors of Obesity in a US Sample of High School Adolescents With and Without Disabilities

BACKGROUND

Childhood obesity is a major public health concern. Children with disabilities have a higher prevalence of obesity.

OBJECTIVE

We examined factors associated with obesity within a cross-sectional study of US adolescents with and without disabilities.

METHODS

Data were obtained from the 2011 Youth Risk Behavior Survey. Logistic regression models were fitted to assess effects of dietary habits, physical activity, and unhealthy weight control behaviors on obesity. Effect modification by disability status was examined.

RESULTS

Twenty percent (1986 of 9775 participants) reported a disability. Adolescents with disabilities were more likely to be obese (odds ratio [OR] = 1.7; 95% confidence interval [CI]: 1.3-2.1) and have at least 1 unhealthy weight control behavior (OR = 2.0; 95% CI: 1.6-2.5), and were less likely to be physically active (OR = 0.5; 95% CI: 0.4-0.6). Lack of physical activity, increased television watching/video game playing, and unhealthy weight loss behaviors were significantly associated with obesity regardless of disability status (p-for-interaction >.05).

CONCLUSIONS

Successful obesity interventions should target diet, physical activity, and weight control among adolescents with disabilities. Understanding barriers to healthier diet and physical activity for this population is critical to developing effective obesity prevention programs and reducing the prevalence of unhealthy weight control behaviors.