Whole Fruits Versus 100% Fruit Juice: (Introduction)
The obesity epidemic has reached concerning levels in the United States (US), with rates tripling since the late 1970s (Kranjac and Kranjac 2023).
This rise in obesity has significant health consequences, including increased risks of chronic conditions such as hypertension, type 2 diabetes, metabolic syndrome and cancer (Clark et al. 2023).
Sugar‐sweetened beverages (SSBs) contain substantial levels of added sugars that have been associated with weight gain and contribute to rising obesity levels (Malik and Hu 2022).
The World Health Organization (WHO)'s definition of free sugars includes not only added sugar in SSBs but also “free sugars” naturally present in products like 100% fruit juices (WHO 2015).
These juices are often perceived as a healthy option, which raises concerns about their potential impact on health if there is no clear definition of, or instruction on, free sugars in dietary guidelines (Sah et al. 2021; WHO 2015).
Dietary guidelines in the US and the underlying scientific literature are inconsistent on whether and to what extent 100% fruit juice should be recommended in the diet.
Those in favour of including fruit juice in the diet suggest that fruit juice is an easy way to help meet the daily fruit recommendations and that it is more than just a source of free sugars, containing useful nutrients alongside (O'neil et al. 2012; Sakaki et al. 2019).
On the flip side, critics emphasise the high sugar content in the form of free sugars in fruit juice and the lack of dietary fibre, which makes it very similar to other SSBs (Guasch‐Ferré and Hu 2019).
Inconsistent recommendations from authoritative bodies, such as the 2020–2025 Dietary Guidelines for Americans (DGA), the American Academy of Paediatrics (AAP), the UK's Eatwell Guide and the Nordic Nutrition Recommendations, further contribute to the debate (Heyman et al. 2017, USDA 2020, Public Health England 2016,
Blomhoff et al. 2023). The 2020–2025 DGA recommends that at least half of the daily recommended fruit intake of two cups a day should come from whole fruits,
implicitly allowing the other half to be fulfilled by 100% fruit juice.
Moreover, the DGA did not explicitly define the sugars in fruit juices as “free sugars”, despite specifying that added sugars should contribute less than 10% of total daily calories (USDA 2020).
According to the WHO's definition, “free sugars” include “all monosaccharides and disaccharides added to foods and beverages by manufacturers, cooks, or consumers, as well as sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates” (WHO 2015).
This is distinct from “intrinsic sugars,” which are naturally incorporated within the structure of whole fruits and vegetables (WHO 2015).
The lack of a clear definition of “free sugars” in fruit juices within the DGA leaves room for ambiguity and may require further clarification to align with international standards.
In contrast, the AAP provides clear recommendations on limits of fruit juice intake in young children's diets: a maximum of 4 oz per day for 1–3 year‐olds, 4–6 oz per day for 4–6 year‐olds, and 8 oz per day for 7–18 year‐olds (8 oz = 236.6 mL).
The AAP also recommends eliminating fruit juice for children experiencing abnormal weight gain (Heyman et al. 2017).
These limits, however, are significantly higher than those recommended in Europe. For example, the UK's Eatwell Guide advises adults to consume a variety of at least five portions of fruits and vegetables per day while limiting 100% fruit juice to 150 mL (equivalent to one portion per day) and explicitly highlights the presence of free sugars in fruit juice (Public Health England 2016).
The recent Nordic Nutrition Recommendations also recommend that intake of fruit juice is limited for children (Blomhoff et al. 2023).
In light of the ongoing disagreements and inconsistent recommendations, this review aims to compare the evidence looking at whole fruits and 100% fruit juice in terms of their nutrient composition, impact on hunger and satiety, and associations with chronic health conditions. The goal is to provide an overview of the scientific evidence to inform and support the updating of healthy dietary recommendations.
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