Consumption of 100% Fruit Juice and Weight Gain: A Re-evaluation

Source: Nguyen M, Jarvis SE, Chiavaroli L, et al. Consumption of 100% fruit juice and body weight in children and adults: a systematic review and meta-analysis [Published online ahead of print January 16, 2024]. JAMA Pediatr. doi: 10.1001/jamapediatrics.2023.6124.Investigators from the University of Toronto, Toronto, Canada, and Harvard University, Boston, MA, conducted a systematic review and meta-analysis to assess the association between consumption of 100% fruit juice and weight gain in children and adults. For the study, they used a standardized process to identify prospective cohort studies of at least 6 months duration and randomized controlled trials in which the intervention lasted ≥2 weeks that evaluated the effects of 100% fruit juice with no added sugar on weight. For included randomized trials, the comparison group consumed non-caloric beverages or usual diet. Data from studies of children (<18 years old) and adults were analyzed separately, and the results of cohort studies and randomized controlled trials also were evaluated separately. The primary outcome of the meta-analysis was change in BMI per every 8-ounce serving of 100% fruit juice per day in studies with pediatric participants and change in weight per daily 8-ounce serving in adults. Data were pooled and analyzed using random-effect models. Analyses with different pediatric age groups also were conducted.Data from 42 articles were included in the systematic review. There were 17 prospective cohort studies in children, but no randomized controlled trials. A total of 25 adult studies were included, with 6 prospective cohort studies and 19 randomized control trials. For the pediatric studies, data on 45,851 children were analyzed. The median baseline age of participants was 8 years, and median study duration was 4 years. Based on the results of the random-effects model, there was a 0.03 (95% CI, 0.01, 0.05) increase in BMI for every 8-ounce serving of 100% fruit juice each day. The increase in BMI was greater in younger children, with those <8 years old having a BMI gain of 0.15 (95% CI, 0.1, 0.29), young 9–13 years of age a gain of 0.01 (95% CI, 0.01, 0.03), and adolescents >14 years old a change in BMI of -0.10 (95% CI, -0.30, 0.10) per serving of fruit juice (P <0.03). A total of 267,362 adults were enrolled in the included cohort studies for a median duration of 3 years. There was no significant association between weight gain and 100% fruit juice intake (pooled estimated change in weight 0.07 kg, 95% CI, -0.06, 0.20). In the meta-analysis of data from randomized controlled trials in adults that included 733 participants with a median study duration of 6 weeks, no significant difference in weight change was found among participants randomized to 100% fruit juice and those randomized to the control group (mean difference, -0.53 kg; 95% CI, -1.55, 0.48).The authors conclude that 1 8-ounce serving per day of 100% fruit juice was associated with BMI gain in children.Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The current investigators address a vexing question facing pediatricians. Is 100% fruit juice good for you? Although 100% fruit juice may provide many of the same nutrients as the whole fruit variety, it also is calorically dense, with high amounts of free sugars and little to no fiber.1 This may lead to low satiety, increased caloric intake, and potentially increased weight gain.2 However, the data on 100% fruit juice and weight gain have thus far been inconclusive.2Further, dietary guidelines on 100% fruit juice are inconsistent. The Dietary Guidelines for Americans allow for 1 serving of 100% fruit juice per day, while the World Health Organization and Canada’s Dietary Guidelines recommending limiting sugars, such as those from 100% fruit juice, to less than 10% of calories per day.3 The American Academy of Pediatrics recommends limiting 100% fruit juice due to concerns for weight gain and dental caries.4The current authors found that even 1 serving of 100% fruit juice is associated with significant weight gain. In an era when pediatric obesity is increasing5 and more than 50% of children ingest at least 1 serving of 100% fruit juice,6 the implication of their finding is to eliminate 100% fruit juice altogether.An important caveat is that the current researchers evaluated the impact of 100% fruit juice. Many fruit juices (eg, apple, cranberry) are supplemented with fructose syrup and other high-density sugars.7 These calorically dense, low-fiber liquids may strengthen the association of fruit juice intake and obesity.Ingestion of even 1 serving of 100% fruit juice is associated with weight gain. (See AAP Grand Rounds. 2019;41[6]:69.)8Lost in all the numbers is the finding that a significant relationship between 100% fruit juice intake and BMI was observed only in children <8 years old.

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