Offering 100 percent juice to children is an issue people love to debate. As with any issue, it is important to try to remove anecdote, personal, and financial bias and look at what the current evidence suggests. (Scroll down to the bottom to get the TL;DR overview.) Some believe it is just as harmful to kid’s health as soda, while others state it is an important way for kids to meet fruit and nutrient recommendations. Is 100 percent fruit juice liquid candy or a health elixir for kids?
Just like adults, kids love to drink their calories. A 2015 study in the Journal of Child Obesity assessed children’s caloric intake from beverages. On average, 18.7 percent of total daily calories for 2- to 18-year-old children came from beverages. Average calories from beverages per day across all ages and weight ranges totaled around 359-386 calories. When you look at caloric intake from 100 percent juice, children consumed an average of 50 calories. However, when the researchers assessed the average caloric intake for kids who consumed 100 percent juice and excluded kids who didn’t drink it from the analysis, the total intakes increases from 50 calories to 147-167 calories on average per day. For comparison, one cup of orange juice has 112 calories.
Fruit juice intake has been on the decline in recent years. According to 24-hour dietary recalls from the National Health and Nutrition Examination Surveys (NHANES), from 2003 to 2010, fruit juice has consumption has decreased an average of 5 percent per year, or 29 percent over that period.
Let’s look at overall fruit intake (which includes 100 percent fruit juice).
As a reminder, one cup of 100 percent fruit juice currently counts as one serving of fruit serving. A 2010 study in the Journal of Nutrition showed that 62.9 percent of children between the ages of 4-8 are not reaching the recommended amount for total fruit (1.5 cups per day including juice intake) and 68.8 percent are not reaching the recommended amount for whole fruit (.75 cups per day without juice).
Kids between the ages of 2-5 consume 40.9 percent of their fruit as juice. A 2015 study in Pediatrics assessed total fruit intake for youth between the ages of 2-19 and found that 100 percent fruit juice makes up around 34 percent of total fruit intake. Kids averaged around .68 cups from whole fruit and .40 cups from fruit juice each day. Citrus juice accounted for 14.3 percent of overall fruit intake, apple juice for 10.3 percent, and other fruit juices were around 9.0 percent.
Like with most health issues, race/ethnicity and income also play a role in increased juice consumption. 100 percent juice consumption appears to be higher with lower income children and in particular among Mexican-American and non-Hispanic black as compared to non-Hispanic whites. A study looking at 4-13 year old lower-income children showed that they consumed significantly more juice than higher-income children did.
This difference in juice consumption patterns among demographic groups could be due to differences in access to free or subsidized juice through school lunch, school breakfast, WIC (only for kids until the age of 5), and child care centers. In the course of any given week, a student could be provided 2 ½ cups of juice at breakfast and 1 ¼ -2 ½ cups of juice at lunch, or up to 8oz a day depending on the grade level.
This is stated not to throw school food service directors, Child and Adult Care Food Program (CACFP), or WIC under the bus. Rightly so, they provide juice out of necessity for cost, ease of storage, preparation, requirements to reach nutrient recommendations, seasonality quality of fruit, and ease of portioning. Similarly, WIC provides juice because the vitamin c found in it or added, has the ability to help support iron absorption from their provided breakfast cereals. WIC has already reduced their juice allotment by half and plan to do so even further in their recently revised food package.
Studies have also assessed the tradeoffs with providing only whole fruit instead of juice. When University of Washington researchers compared different whole fruit and juice combinations to reach recommendations, the whole fruit alone model resulted in a significantly higher cost and had smaller gains for potassium, calcium, and vitamin C. Only using whole fruit to reach recommendations increased diet costs by $.21 a day compared to the combination of whole fruit and fruit juice. Another study looking at substituting whole fruit for juice showed when you traded juice for whole fruit you would gain about 1 gram of fiber and reduce your sugar consumption by 5.7 grams. You would also reduce your vitamin C intake by 19.8 mg.
A 2012 study looking specifically at orange juice (OJ) found on average, children consumed OJ above the 4 ounces recommended by the American Academy of Pediatrics (AAP). On average, kids 1-6 years old drank 7.7 ounces per day. Although kids exceeded the AAP recommendations, consumption of OJ was positively associated with improved nutrient adequacy, diet quality, and health parameters and was not associated with overweight or obesity in all children.
Research shows that OJ and soda are not equivalent from a health or diet quality standpoint. Systematic reviews (review of multiple studies on the subject matter) show increased risk for cardiovascular disease, type 2 diabetes, and high blood pressure with sugar sweetened beverage consumption. Other studies have shown that sugar sweetened beverages contribute to unhealthy weight gain in children and adolescents. This is in contrast to a 2015 systematic review that did not show these negative outcomes with 100% fruit juice. The authors of this review stated that, “In context of a healthy dietary pattern, evidence suggests that consumption of 100 percent fruit juice may provide beneficial nutrients without contributing to pediatric obesity.”
Dental caries (decay and crumbling teeth or bone) should also be part of the conversation when it comes to 100% juice. Contrary to popular belief, 100 percent juice has not been strongly associated with early childhood caries, unlike with soda.
Current evidence shows that 100% juice is not as bad as soda, but this is not to say we should promote unlimited 100% juice consumption.
Having children practice regulating hunger and fullness cues is an important learned behavior. Nutrition researchers have shown concern with liquid calories not providing the same “satiety cues.” Researches have made the argument that sugar consumption in the absence of dietary fiber is associated with excess weight gain, liver injury, and metabolic syndrome. A 2012 study in adults comparing liquid vs. solid food intake demonstrated increased hunger after consuming a liquid beverage and increased calorie intake at following meals. More research is needed to provide substantial evidence for this satiety concept, especially with children.
Drinking fruit juice compared to eating whole fruit can increase calorie intake. ½ cup of grape juice contains 76 calories while a ½ cup of fresh grapes has only 34 calories. One cup of orange juice has 112 calories compared to 62 calories from an orange.
Kids on average also fall far short on reaching fiber recommendations of 19-25 grams per day. Eating whole fruits instead of juice helps kids consume more fiber. Eating an apple instead of apple juice would provide you 4.4 grams of fiber compared to 0 grams from juice.
Nutrition researcher Matthew Dalby did some excellent sleuthing and found two interesting studies that assessed the difference of feeding people processed variations of apples, oranges, and grapes. For the first study, researchers fed 10 healthy volunteers either 60 grams of blended, juiced, or whole apples after fasting overnight. Blood sugar rose similarly for all three, but instead of returning to normal levels after drinking the smoothie or juice the volunteers blood sugar dropped below fasting levels and remained lower for at least a couple of hours when they consumed the blended, or juiced apples.
As Matthew put it, “This means that removing the fibre from the apple, or even just breaking up the physical structure of the fibre, contributes to disrupting the normal mechanisms that regulate blood sugar and insulin after drinking it, compared to eating the fruit whole. If repeated regularly these inappropriately insulin responses and falls in blood sugar after drinking juice seem unlikely to be very good for you.”
The follow up study that looked at oranges and grapes only found similar findings for oranges, but not with grapes. Matthew paraphrased it as “This follow-up study confirms that effects for apples and oranges are similar. That is, there is not much difference in blood glucose spikes between fruit and juice, but there is a greater increase in insulin production and prolonged reactive hypoglycemia after drinking juice. The results for the grapes just goes to show how variable results can be in nutritional science when comparing between different foods.”
Overall he stated, “In general, it seems that eating some fruit is probably metabolically healthier than drinking fruit juice, although a little caution may be in order before generalising (sic) this to every type of fruit.” These studies do not paint such an innocent picture for juice consumption, but again these were done with adults and not kids. As always, more research is needed.
Lastly, researchers at Boston Children’s Hospital and the Department of Pediatrics at Harvard Medical Center have made the argument that consuming juice could be a “gateway behavior” that might put children at greater risk of unhealthy weight gain later in life. They stated, “The lack of consistent evidence linking juice intake to weight status does not preclude a role of early beverage consumption on later obesity. If juice consumption at young ages is associated with greater consumption of sweetened beverages at later ages, potentially through its impact on taste preferences.” So, drinking juice as a child could set a higher preference for sweetness in their future.
In the end, what should a parent/family member do? (TL;DR)
To answer our initial question - Is juice a health elixir or liquid candy? Simply put, it is neither.
- Currently, research does not show 100% juice to be as detrimental to health as other sugary drinks in regards to unhealthy weight gain and diet quality.
- Upgrading a can of Coke to a 4oz serving of OJ would be a nutrition step in the right direction.
- However, drinking juice instead of eating whole fruit may increase calorie intake, decrease fiber, increase total sugar intake, and set a taste preference for sweeter beverages in the future.
- Like with most subjects in nutrition, we need to continue to build a base of highly quality research to assess the 100% juice debate. Most are currently based off dietary recalls, which all researchers will admit have their issues.
- Trade-offs are involved with convenience, cost, seasonality of whole fruit, and reaching nutrient recommendations with 100% juice vs. whole fruit debate that should be considered.
- Low-income populations might be at greater risk with having above recommended amounts of fruit consumption from 100% juice.
- 100% juice works especially well to meet fruit recommendations in food assistance program settings due to the previous listed constraints (I.e. if we want to provide children whole fruit, give these programs more resources).
- As a family, make water the default beverage for meals. You do not need to consume 100% juice to have a healthy diet.
- Offer pasteurized, 100% juices like orange, prune, tomato, and carrot juice that contain a significant amount of potassium (since almost no one reaches the potassium recommendation), which has been shown to reduce blood pressure.
- Follow the American Academy of Pediatrics recommendations for fruit juice to be limited to 4 to 6 oz per day for children 1 to 6 years old. For children 7 to 18 years old, juice intake should be limited to 8 to 12 oz.
- Purchase 4oz cups to help with proper portioning. Avoid buying juice out since most settings serve it in larger portions.