Increased servings of 100% fruit juice per day associated with BMI gain in children

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Though the association of BMI gain and 100% fruit juice in children was “small,” authors concluded their findings support public health guidance to limit consumption of the beverage to prevent overweight and obesity.

Increased servings of 100% fruit juice per day associated with BMI gain in children | Image Credit: © Drobot Dean - © Drobot Dean - stock.adobe.com.

Increased servings of 100% fruit juice per day associated with BMI gain in children | Image Credit: © Drobot Dean - © Drobot Dean - stock.adobe.com.

Takeaways:

  • A systematic review and meta-analysis published in JAMA Pediatrics included 42 studies, comprising 17 among children, to assess the association between 100% fruit juice consumption and body weight in children and adults.
  • The study involved 45,851 children and 268,095 adults, and data were pooled using random-effects models, with results presented as β coefficients with 95% CIs.
  • The primary outcome was a change in BMI per every 8-oz serving per day increment of 100% fruit juice, and a separate analysis assessed the association of fruit juice with BMI z score in prospective cohort studies in children.
  • For every 8-oz serving per day of 100% fruit juice, a small but significant BMI gain association of 0.03 (CI, 0.01-0.05) was observed in children, supporting public health guidance to limit 100% fruit juice consumption to prevent overweight and obesity.

Results from a systematic review and meta-analysis recently published in JAMA Pediatrics revealed that 1 serving per day of 100% fruit juice was associated with body mass index (BMI) gain in children.

Concerns exist that often consumption of 100% fruit juice could promote weight gain, though mixed signals have been presented from observational studies and clinical trials. The drink can be a convenient way to meet fruit recommendations while offering nutrients found in whole fruit such as antioxidants, vitamins, and polyphenols.

High amounts of free sugars and energy associated with 100% fruit juice have caused concerns too. The drinks “contain little to no fiber compared with the whole fruit form, resulting in low satiety and greater ad libitum energy intake,” said the study authors.

International guidelines on 100% fruit juices are inconsistent as well. The American Academy of Pediatrics has differing recommendations based on age groups for children, with concerns for dental caries and obesity, while The Dietary Guidelines for Americans “permits 100% fruit juice as a serving of fruit and recommends limiting added sugars,” the study reads.

Investigators sought to evaluate available evidence on 100% fruit juice consumption and body weight in children and adults. In doing so, their systematic review included 42 studies, including 17 among children. In total, the studies featured 45,851 children and 268,095 adults.

Data were pooled using random-effects models and presented as β coefficients with 95% CIs, the investigators wrote.

The cohort studies included in the review and meta-analysis were ones of at least 6 months and were randomized clinical trials that assessed 100% fruit juice with relation to body weight change in children and adults. Noncaloric controls were used to compare fruit juices.

The primary outcome of the review was a change in BMI per every 8-oz serving per day increment of 100% fruit juice. The primary analysis, stated investigators, “used estimates not adjusted for total energy intake when available, and a separate meta-analysis using estimates adjusted for total energy intake was conducted,” because of potential mediation of energy intake on the association being reviewed.

A separate meta-analysis assessed the association of fruit juice with BMI z score in prospective cohort studies in children.

For every 8-oz serving per day of 100% fruit juice, pooled estimates using a random-effects model revealed a 0.03 (CI, 0.01-0.05) higher BMI in children. The analysis revealed a substantial between-study heterogeneity (I2 = 85%; P for heterogeneity <.001).

There was no significant association found for the change in fruit juice intake with concomitant change in BMI (0.01 [CI, -0.03 to 0.04]). Scaled to a 1-year period using the studies’ energy-adjusted estimates, the positive association was still present.

In BMI z scoring, each additional serving per day of the 100% fruit juice was associated with a 0.01 higher BMI score (95% CI, 0.001-0.02).

Overall, results demonstrated a small BMI-gain association with 100% fruit juice in children, leading the authors to conclude that findings are “in support of public health guidance to limit consumption of 100% fruit juice to prevent overweight and obesity.”

Reference:

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. JAMA Pediatr. Published online January 16, 2024. doi:10.1001/jamapediatrics.2023.6124

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