Fruit Juice: Just Another Sugary Drink?
Posted: Tue Feb 18, 2014 11:07 am
Fruit Juice: Just Another Sugary Drink?
Lancet Diabetes Endocrinol 2014
Published Online
February 10, 2014 http://dx.doi.org/10.1016/ S2213-8587(14)70013-0
Highlights from the article (which is online and free to subscribers (which is free).
"By contrast with the growing consensus to limit SSB (Sugar Sweetened Beverage) intake, consumption of fruit is regarded as virtuous, with WHO guidelines recommending consumption of fruit and vegetables—eg, in the UK, the guidelines recommend five servings per day, and one of these portions can be in the form of fruit juice."
"However, fruit juice has a similar energy density and sugar content to SSBs: 250 ml of apple juice typically contains 110 kcal and 26 g of sugar; 250ml of cola typically contains 105 kcal and 26·5 g of sugar."
"Additionally, by contrast with the evidence for solid fruit intake, for which high consumption is generally associated with reduced or neutral risk of diabetes,7 high fruit juice intake is associated with increased risk of diabetes.7,8"
"Of course, SSBs and pure fruit juices are not identical— unlike (unfortified) SSBs, fruit juices contain vitamins and minerals, so could conceivably be of value for individuals consuming micronutrient-poor diets."
"However, this micronutrient content might not be sufficient to offset the adverse metabolic consequences of excessive fruit juice consumption—eg, consumption of 480 ml of high-antioxidant concord grape juice per day for 3 months increased insulin resistance and waist circumference in overweight adults in one randomised controlled trial.9"
"Thus, contrary to the general perception of the public, and of many health-care professionals, that drinking fruit juice is a positive health behaviour, their consumption might not be substantially different in health terms from consumption of SSBs."
"We hypothesised that public perception of the healthiness of fruit juices might be based on poor awareness of their sugar content. To test this, we surveyed a nationally representative group of 2005 adults, living across the UK, using validated online polling methods,10 to assess knowledge of sugar content of a range of SSBs, fruit juices, and smoothies. We showed participants pictures of full containers of different non-alcoholic beverages and asked them to estimate the number of teaspoons of sugar contained in the portion shown. Although the sugar content of all drinks presented was similar, the sugar content of fruit juices and smoothies was underestimated by 48% on average, whereas the sugar content of carbonated drinks was overestimated by 12%."
"Thus, there seems to be a clear misperception that fruit juices and smoothies are low-sugar alternatives to SSBs."
"...the inclusion of any fruit juice at all as a fruit-equivalent in this recommendation is probably counterproductive because it fuels the perception that drinking fruit juice is good for health, and thus need not be subject to the limits that many individuals impose on themselves for consumption of less healthy foods. "
"A further, more radical suggestion would be to re-examine whether any fruit intake in the form of juices should be permissible within guidelines for daily fruit and vegetable intake. This change would be in line with calls in the USA that recommend elimination of all fruit juice consumption by children.11"
"Many would now agree that policies and guidance should be put into place to limit intake of SSBs. We suggest that, like SSBs, fruit juices are sugary drinks with a probable net adverse effect on health. A fruit juice tax is probably not warranted; however, in the broader context of public health policy, it is important that debate about SSB reduction should include fruit juice."
1 Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis.
Am J Clin Nutr 2013; 98: 1084–102.
2 Rippe JM. The metabolic and endocrine response and health implications of consuming sugar-sweetened beverages: findings from recent randomized controlled trials. Adv Nutr 2013; 4: 677–86.
3 Sievenpiper JL, de Souza RJ. Are sugar-sweetened beverages the whole story? Am J Clin Nutr 2013; 98: 261–63.
4 Almiron-Roig E, Palla L, Guest K, et al. Factors that determine energy compensation: a systematic review of preload studies. Nutr Rev 2013; 71: 458–73.
5 Bates B, Lennox A, Prentice A, Bates C, and Swan G. National Diet
and Nutrition Survey: headline results from years 1, 2 and 3 (combined) of the Rolling Programme (2008/2009–2010/11). Department of Health and Food Standards Agency; 2012. http://webarchive.nationalarchives. gov.uk/20130402145952/http://transparency.dh.gov.uk/2012/07/25/ ndns-3-years-report/ (accessed Feb 2, 2014).
6 Academy of Medical Royal Colleges. Measuring up: the medical profession’s prescription for the nation’s obesity crisis. London: Academy of Medical Royal Colleges, 2013.
7 Muraki I, Imamura F, Manson JE, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ 2013; 347: f5001.
8 Odegaard AO, Koh WP, Arakawa K, Yu MC, Pereira MA. Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study. Am J Epidemiol 2010; 171: 701–08.
9 Hollis JH, Houchins JA, Blumberg JB, Mattes RD. Effects of concord grape juice on appetite, diet, body weight, lipid profile, and antioxidant status of adults. J Am Coll Nutr 2009; 28: 574–82.
10 Sparrow N. Developing reliable online polls. Int J Mark Res 2006; 48: 659–80.
11 Wojcicki JM, Heyman MB. Reducing childhood obesity by eliminating 100% fruit juice. Am J Public Health 2012; 102: 1630–33.
Lancet Diabetes Endocrinol 2014
Published Online
February 10, 2014 http://dx.doi.org/10.1016/ S2213-8587(14)70013-0
Highlights from the article (which is online and free to subscribers (which is free).
"By contrast with the growing consensus to limit SSB (Sugar Sweetened Beverage) intake, consumption of fruit is regarded as virtuous, with WHO guidelines recommending consumption of fruit and vegetables—eg, in the UK, the guidelines recommend five servings per day, and one of these portions can be in the form of fruit juice."
"However, fruit juice has a similar energy density and sugar content to SSBs: 250 ml of apple juice typically contains 110 kcal and 26 g of sugar; 250ml of cola typically contains 105 kcal and 26·5 g of sugar."
"Additionally, by contrast with the evidence for solid fruit intake, for which high consumption is generally associated with reduced or neutral risk of diabetes,7 high fruit juice intake is associated with increased risk of diabetes.7,8"
"Of course, SSBs and pure fruit juices are not identical— unlike (unfortified) SSBs, fruit juices contain vitamins and minerals, so could conceivably be of value for individuals consuming micronutrient-poor diets."
"However, this micronutrient content might not be sufficient to offset the adverse metabolic consequences of excessive fruit juice consumption—eg, consumption of 480 ml of high-antioxidant concord grape juice per day for 3 months increased insulin resistance and waist circumference in overweight adults in one randomised controlled trial.9"
"Thus, contrary to the general perception of the public, and of many health-care professionals, that drinking fruit juice is a positive health behaviour, their consumption might not be substantially different in health terms from consumption of SSBs."
"We hypothesised that public perception of the healthiness of fruit juices might be based on poor awareness of their sugar content. To test this, we surveyed a nationally representative group of 2005 adults, living across the UK, using validated online polling methods,10 to assess knowledge of sugar content of a range of SSBs, fruit juices, and smoothies. We showed participants pictures of full containers of different non-alcoholic beverages and asked them to estimate the number of teaspoons of sugar contained in the portion shown. Although the sugar content of all drinks presented was similar, the sugar content of fruit juices and smoothies was underestimated by 48% on average, whereas the sugar content of carbonated drinks was overestimated by 12%."
"Thus, there seems to be a clear misperception that fruit juices and smoothies are low-sugar alternatives to SSBs."
"...the inclusion of any fruit juice at all as a fruit-equivalent in this recommendation is probably counterproductive because it fuels the perception that drinking fruit juice is good for health, and thus need not be subject to the limits that many individuals impose on themselves for consumption of less healthy foods. "
"A further, more radical suggestion would be to re-examine whether any fruit intake in the form of juices should be permissible within guidelines for daily fruit and vegetable intake. This change would be in line with calls in the USA that recommend elimination of all fruit juice consumption by children.11"
"Many would now agree that policies and guidance should be put into place to limit intake of SSBs. We suggest that, like SSBs, fruit juices are sugary drinks with a probable net adverse effect on health. A fruit juice tax is probably not warranted; however, in the broader context of public health policy, it is important that debate about SSB reduction should include fruit juice."
1 Malik VS, Pan A, Willett WC, Hu FB. Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis.
Am J Clin Nutr 2013; 98: 1084–102.
2 Rippe JM. The metabolic and endocrine response and health implications of consuming sugar-sweetened beverages: findings from recent randomized controlled trials. Adv Nutr 2013; 4: 677–86.
3 Sievenpiper JL, de Souza RJ. Are sugar-sweetened beverages the whole story? Am J Clin Nutr 2013; 98: 261–63.
4 Almiron-Roig E, Palla L, Guest K, et al. Factors that determine energy compensation: a systematic review of preload studies. Nutr Rev 2013; 71: 458–73.
5 Bates B, Lennox A, Prentice A, Bates C, and Swan G. National Diet
and Nutrition Survey: headline results from years 1, 2 and 3 (combined) of the Rolling Programme (2008/2009–2010/11). Department of Health and Food Standards Agency; 2012. http://webarchive.nationalarchives. gov.uk/20130402145952/http://transparency.dh.gov.uk/2012/07/25/ ndns-3-years-report/ (accessed Feb 2, 2014).
6 Academy of Medical Royal Colleges. Measuring up: the medical profession’s prescription for the nation’s obesity crisis. London: Academy of Medical Royal Colleges, 2013.
7 Muraki I, Imamura F, Manson JE, et al. Fruit consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies. BMJ 2013; 347: f5001.
8 Odegaard AO, Koh WP, Arakawa K, Yu MC, Pereira MA. Soft drink and juice consumption and risk of physician-diagnosed incident type 2 diabetes: the Singapore Chinese Health Study. Am J Epidemiol 2010; 171: 701–08.
9 Hollis JH, Houchins JA, Blumberg JB, Mattes RD. Effects of concord grape juice on appetite, diet, body weight, lipid profile, and antioxidant status of adults. J Am Coll Nutr 2009; 28: 574–82.
10 Sparrow N. Developing reliable online polls. Int J Mark Res 2006; 48: 659–80.
11 Wojcicki JM, Heyman MB. Reducing childhood obesity by eliminating 100% fruit juice. Am J Public Health 2012; 102: 1630–33.