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100% Juice – Truth vs. Pulp Fiction

Wednesday, November 5, 2014



Today’s Moderator

Nadia Egziabher Child Nutrition and Policy Coordinator

School Nutrition Association



Questions & Answers

• Type your questions into the “Question” box at any time during the webinar

• Questions will be addressed during the webinar and at the end as time allows



Today’s Panelists

Diane Welland M.S., R.D. Manager of Nutrition

Communications Juice Products Association

Adam Drewnowski, PhD Director, Center for Public Health

Nutrition University of Washington

100% Fruit Juice Truth vs Pulp Fiction

6

Nov 2014

Diane Welland M.S., R.D. Manager of Nutrition

Communications Juice Products Association

7

JPA is the trade association representing the fruit and juice products industry. Our members

are processors, packers, extractors, brokers and marketers of fruit and vegetable juices

and juice beverages. Visit our consumer resource site at www.juicecentral.org

About the Juice Products Association

http://www.juicecentral.org/

2010 Dietary Guidelines Fruit Group Recommendation

• 2 to 4 servings or 1 to 2 cups of fruits per day • Recommendation depends on age and level of physical activity

What is 1 equivalent cup of fruit?

• ½ cup dried fruit • 1 cup of 100% fruit juice

2010 Dietary Guidelines for Americans & MyPlate Current Fruit Group Recommendations for Nutrient Adequacy 8

* Whole fruit recommended as majority of fruit intake

9

Ages 1 to 6 years: No more than 4 to 6 ounces per day

Ages 7 to 18 years: No more than 8 to 12 ounces per day

• Existing AAP guidelines remain consistent

with most current body of scientific evidence (Nov 2014)

Current American Academy of Pediatric 100% Fruit Juice Intake Guidelines

American Academy of Pediatrics (May 2001, reaffirmed 2006)

10

100% fruit juice: Truth versus pulp fiction

Adam Drewnowski, PhD Director, Center for Public Health Nutrition

UW Center for Obesity Research Nutritional Sciences Program

Professor of Epidemiology; Adjunct Professor of Medicine University of Washington, Seattle, WA, USA

The role of 100% fruit juice in diet quality of children SNA webinar November 3, 2014

• A. Drewnowski has received grants, honoraria, and consulting fees from numerous food, beverage, and ingredient companies and from other commercial and nonprofit entities with an interest in nutrient density of foods. The University of Washington receives research funding from both public and private sectors.

• Analyses of publicly available federal datasets (National Health and Nutrition Examination Surveys) were supported by funds from the Juice Products Association to the UW Center for Public Health Nutrition.

• Data analyses have been submitted for publication in peer-review professional journals.

Disclosure

MyPlate: Eat more fruit

In general, 1 cup of fruit or 100% fruit juice, or ½ cup of dried fruit can be considered as 1 cup from the Fruit Group.

Some dietary guidelines (not all) favor whole fresh fruit • MyPlate says:

– Make half your plate fruits and vegetables. • Dietary Guidelines 2005 and 2010 say:

– Eat more fruit • But some experts favor whole fruit over 100% fruit juice. • The Healthy Eating Index 2005 (and 2010) awards extra point

to whole fruit. • What are fruit servings?

– In general, 1 cup of fruit or 100% fruit juice, – or ½ cup of dried fruit can be considered as 1 cup from the Fruit Group.

• Do whole fruit and 100% juice cost the same? • What is the proportion of whole fruit versus

100% juice in the diet? • Is there a socioeconomic gradient in the

consumption of whole fruit versus 100% juice? • Which groups consume least whole fruit? • What is the extent of fruit shortfall in the diet? • How can the fruit guidelines be met? • Can meeting dietary guidelines for fruit be cost

neutral? • How can 100% fruit juices best be used?

Outline: some key questions

Price data CNPP price database

2001-2 NHANES

Nutrient composition

data FNDDS 1.0 USDA

4500 foods

What do different foods cost? Energy Density

Kcal/100g

Nutrient cost

Nutrient density

Energy Cost

$/1000 kcal

What foods provide maximum calories per dollar?

Food price and quality

What foods provide maximum nutrients per calorie and per

dollar?

What is energy density? Water content

0 100 200 300 400 500 600 700 800 900

Oil

Animal fat

Salty snacks

Deli meat

Pastries

Sugar

Cheese

Meat mixed dishes

Fatty fish

Meat

Poultry

Eggs

Whole grains

Refined grains

Fish

Shellfish

Dairy products

Fruit

Milk

SSB

Fruit juices

Veg mixed dishes

Vegetables

Tap water

ED (kcal/100g)

0

100

200

300

400

500

600

700

800

900

0.1 1 10 100Energy cost ($/1000 kcal)

Ener

gy d

ensi

ty (k

cal/1

00g)

Grains Fats Sugars

Log scale

Grains, sugars, and fats are cheapest Data from USDA FNDDS 1.0 and CNPP prices database

oils

cereals

Lower cost

Higher cost

sugar

beverages

desserts

pasta

0

100

200

300

400

500

600

700

800

900

0.1 1 10 100Energy cost ($/1000 kcal)

Ener

gy d

ensi

ty (k

cal/1

00g)

Dairy Meat Eggs Beans

Log scale

nuts

eggs

shellfish

fish

Lower cost

Higher cost

beans

meat

yogurt

Meat and fish cost more per kcal Data from USDA FNDDS 1.0 and CNPP prices database

0

100

200

300

400

500

600

700

800

900

0.1 1 10 100Energy cost ($/1000 kcal)

Ener

gy d

ensi

ty (k

cal/1

00g)

Fruits Vegetables

Log scale

Salad greens

Whole fresh fruit

Lower cost

Higher cost

potatoes

fried potatoes

dried fruit

canned fruit

Vegetables and fruit cost most per kcal Data from USDA FNDDS 1.0 and CNPP prices database

100% juice

0

100

200

300

400

500

600

700

800

900

0.1 1 10 100Energy cost ($/1000 kcal)

Ener

gy d

ensi

ty (k

cal/1

00g)

Dairy Meat Eggs Beans Grains Fruits Vegetables Fats Sugars

Log scale

nuts

Salad greens

whole fruit

Lower cost

Higher cost

beans

meat

yogurt

cheese

milk

pasta

cereals

oil

sugar

Fresh produce can be more expensive – but there are many options

Do healthier diets cost more?

Key question

Component Points Std. for max. score Std. for min. score Total Fruit (includes 100% juice) 5 ≥0.8 cup equiv. per 1,000 kcal No Fruit

Whole Fruit (not juice) 5 ≥0.4 cup equiv per 1,000 kcal No Whole Fruit

Total Vegetables 5 ≥1.1 cup equiv. per 1,000 kcal No vegetables

Dark Green and Orange Vegetables and Legumes

5

≥0.4 cup equiv. per 1,000 kcal No Dark Green or Orange Vegetables and Legumes

Total Grains 5 ≥3.0 oz equiv. per 1,000 kcal No Grains

Whole Grains 5 ≥1.5 oz equiv. per 1,000 kcal No Whole Grains

Milk 10 ≥1.3 cup equiv. per 1,000 kcal No Milk

Meat and Beans 10 ≥2.5 oz equiv. per 1,000 kcal No Meat or Beans

Oils 10 ≥12 grams per 1,000 kcal No Oil

Saturated Fat 10 ≤7% of energy ≥15% of energy

Sodium 10 ≤0.7 gram per 1,000 kcal ≥2.0 g per 1,000 kcal

Calories from Solid Fat, Alcohol, and Added Sugar (SoFAAS)

20 ≤20% of energy ≥50% of energy

Healthy Eating Index 2005: Eat whole fruit

22

Healthy Eating Index - 2005

23

• We attached national food prices to all foods eaten by NHANES participants (NHANES 2001-2).

• We then calculated diet costs for each person. • First, we looked at quintiles of diet costs and

examined the impact on HEI 2005 scores (total HEI and components).

• Second, we looked at consumption of different food groups (including 100% fruit juice and whole fruit) and examined their impact on cost.

• The study was published in AJCN 2011.

0

10

20

30

40

50

60

70

q1 q2 q5

HEI 2

005

com

pone

nt

Solid fat, alcohol, added sugar (20)

Sodium (10)

Saturated fat (10)

Oils (10)

Meat and beans (10)

Milk (10)

Whole grains (5)

Total grains (5)

Dark green and orange vegetables (5)

Total vegetables (5)

Non-juice fruit (5)

Total fruit (5)

men

Higher diet costs = more fruit Rehm Monsivais Drewnowski AJCN2011:94:1333-9

Energy adjusted quintiles of diet cost

Whole fruit

0

10

20

30

40

50

60

70

80

q1 q2 q5

HEI 2

005

com

pone

nt

Solid fat, alcohol, added sugar (20)

Sodium (10)

Saturated fat (10)

Oils (10)

Meat and beans (10)

Milk (10)

Whole grains (5)

Total grains (5)

Dark green and orange vegetables (5)

Total vegetables (5)

Non-juice fruit (5)

Total fruit (5)

women

Energy adjusted quintiles of diet cost

Higher diet costs = more fruit Rehm Monsivais Drewnowski AJCN2011:94:1333-9

Whole fruit

-30

0

30

60

90

120

150

180

Q1 Q2 Q3 Q4 Q5

Dark green, orange vegWhole fruitTotal fruitTotal vegetablesWhole grainsMilkMeat & beans

Quintiles of energy adjusted nutrient intakes

Cos

t as

% c

hang

e fro

m Q

1

Some food groups cost more

More fruit = higher diet costs

-30

0

30

60

90

120

150

180

Q1 Q2 Q3 Q4 Q5

Dark green, orange vegWhole fruitTotal fruitOilsTotal grains

Quintiles of energy adjusted nutrient intakes

Cos

t as

% c

hang

e fro

m Q

1

Some food groups cost less

More fruit = higher diet costs

Component Points Std. for max. score Std. for min. score Total Fruit (includes 100% juice) 5 ≥0.8 cup equiv. per 1,000 kcal No Fruit

Whole Fruit (not juice) 5 ≥0.4 cup equiv. per 1,000 kcal No Whole Fruit

Total Vegetables 5 ≥1.1 cup equiv. per 1,000 kcal No Vegetables

Greens and beans 5

≥0.2 cup equiv. per 1,000 kcal No Dark Green Vegetables or beans and peas

Whole Grains 10 ≥1.5 oz equiv. per 1,000 kcal No Whole Grains

Dairy 10 ≥1.3 cup equiv. per 1,000 kcal No Dairy

Total Protein Foods 5 ≥2.5 oz equiv. per 1,000 kcal No Protein Foods

Seafood and plant proteins 5 ≥0.8 oz equiv. per 1,000 kcal No seafood/plant proteins

Fatty acids 10 (PUFA+MUFA)/SFA>2.5 Ratio <1.2

Refined grains 10 <1.8 oz equiv per 1000 kcal ≥4.3 oz equiv

Sodium 10 ≤1.1 gram per 1,000 kcal ≥2.0 g per 1,000 kcal

Calories from Solid Fat, Alcohol, and Added Sugar (SoFAAS)

20 ≤19% of energy ≥50% of energy

Healthy Eating Index - 2010

28

SES gradient also in HEI 2010 scores (2009-10 NHANES) Rehm et al (under review)

Quintiles of diet cost

Whole fruit

• Data analyses of NHANES 2007-2010. • We examined socio-demographic

factors related to the consumption of whole fruit versus 100% fruit juice.

• Socio-demographic factors were: • Gender (male, female)

• Age group (4-13y, 14-19y,20-50y and >50y)

• Income to poverty ratio: <1.3; 1.3 to 3.5; >3.5

• Race/ethnicity

More analyses of federal data

Who is most likely to eat whole fruit?

Key question

0

0.25

0.5

0.75

1

1.25

1.5

4-13y 14-19y 20-50y >50y

100% juiceWhole fruit

Age group (y)

Children and older adults eat more fruit Se

rvin

gs

younger older

0

0.25

0.5

0.75

1

1.25

1.5

4-13y 14-19y 20-50y >50y

Shortfall100% juiceWhole fruit

Age group (y)

Teens and young adults have fruit shortfall Se

rvin

gs

0

0.25

0.5

0.75

1

1.25

1.5

<1.3 1.3-3.5 >3.5


Age group (y)

Poor people eat less total fruit Se

rvin

gs

More poor Less poor

0

0.25

0.5

0.75

1

1.25

1.5

<1.3 1.3-3.5 >3.5

Shortfall100% juiceWhole fruit

Age group (y)

Poor people have more fruit shortfall Se

rvin

gs

0

0.25

0.5

0.75

1

1.25

1.5

<High School High School Some college College


College graduates (>25y) eat more total fruit Se

rvin

gs

0

0.25

0.5

0.75

1

1.25

1.5

Mexican American Other Hispanc NH White NH Black


Minorities eat more total fruit and 100%juice Se

rvin

gs

NH Whites eat least total fruit !!!!

0102030405060708090

100

4-13y 14-19y 20-50y >50y

MaleFemale

Age group (y)

But there is a major population fruit shortfall: 70% of the US!

Perc

ent b

elow

1.5

serv

ings

per

day

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

4-13y 14-19y 20-50y >50y

<1.31.3-3.5>3.5

Higher income children and teens eat much more whole fruit

Age group (y)

Mea

n se

rvin

gs

IPR

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

4-13y 14-19y 20-50y >50y

<1.31.3-3.5>3.5

Age group (y)

Less income effect for 100% fruit juice M

ean

serv

ings

IPR

0102030405060708090

100

4-13y 14-19y 20-50y >50y

<1.31.3-3.5>3.5

Age group (y)

Higher income groups get a higher proportion of total fruit from whole fruit, not 100% juice

Perc

ent i

ntak

e

Income to poverty Ratio or IPR

• What would it take to meet the total fruit shortfall in a cost-neutral way?

• Would it be whole fruit only? • Would it be whole fruit and 100% juice? • Amounts of 100% juice capped by the

American Academy of Pediatrics. • Data modeled for 4-13y age group.

• Model 1: whole fruit only. • Model 2: whole fruit and 100% juice.

Some modeling analyses

Modeling to meet recommendations. Ages 4-13y (n=1071)

0

20

40

60

80

100

120

140

IPR<1.3 IPR 1.3-3.49 IPR ≥3.5 Vi

tam

in C

(mg)

Vitamin C (mg)

Observed (95% CI) Model 1 (95% CI)

Model 2 (95% CI)

0

500

1000

1500

2000

2500

3000

IPR<1.3 IPR 1.3-3.49 IPR ≥3.5

Pota

ssiu

m (m

g)

Potassium (mg)


Model 2 (95% CI)

Model 1 = fruit; Model 2 = fruit and 100% juice

More potassium; more vitamin C (model 2)

0

2

4

6

8

10

12

14

16

18

IPR<1.3 IPR 1.3-3.49 IPR ≥3.5

Fibe

r (gm

)

Fiber (gm)


Model 2 (95% CI)

0

200

400

600

800

1000

1200

1400

IPR<1.3 IPR 1.3-3.49 IPR ≥3.5 Ca

lciu

m (m

g)

Calcium (mg)


Model 2 (95% CI)


Model 1 = fruit; Model 2 = fruit and 100% juice

More fiber (model 1); more calcium (model 2)

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

IPR<1.3 IPR 1.3-3.49 IPR ≥3.5 Pr

ice

($/d

)

Price ($/d)


Model 2 (95% CI)

0

500

1000

1500

2000

2500

IPR<1.3 IPR 1.3-3.49 IPR ≥3.5

Ener

gy (k

cal)

Energy (kcal)


Model 2 (95% CI)


Same dietary energy; not higher cost (model 2)

Conclusion

• MyPlate says: – Make half your plate fruits and vegetables.

• Dietary Guidelines 2005 and 2010 say: – Eat more fruit

• Analyses of federal data show that these is a social gradient in whole fruit consumption (education, incomes).

• Modeling shows how the fruit shortfall can be satisfied using whole fruit and 100% juice.

• Fruit alone is more expensive; fruit and juice are cost neutral.

• Combination of fruit and 100% fruit juice provides a cost neutral way of meeting the widespread fruit shortfall.

Conclusion

100% fruit juice plays an important role in helping American children meet the recommended fruit group daily servings

100% fruit juice delivers significant nutrients in the

diets of children

Facts About 100% Fruit Juice 48

100% Fruit Juice Plays a Critical Role in Providing Important Vitamins & Minerals

100% fruit juice is a top contributor to dietary intake of: • Potassium • Vitamin C* • Folate • Magnesium • Calcium* and Vitamin D*

In some cases, drinking 100% fruit juice may provide more phytonutrients than the whole fruit

* May come from fortified juices

49

100% Fruit Juice Delivers Significant Nutrients in the Diets of Children

Oranges Apples

½ cup sections

½ cup FJ

1whole fruit

½ cup slices

½ cup FJ

1whole fruit

Servings (weight) 90 g 124.5 g 131 g 54.5 g 124 g 149 g

Energy (kcal) 42 61 62 28 57 77

Carbohydrate (g) 10.58 14.37 15.39 7.53 14.01 20.58

Sugars, total (g) 8.42 10.35 12.25 5.66 11.93 15.48

Dietary Fiber, total (g) 2.2 0.4 3.1 1.3 0.2 3.6

Calcium (mg) 36 14 52 3 10 9

Magnesium (mg) 9 14 13 3 6 7

Potassium (mg) 163 222 237 58 125 159

Vitamin A, RAE (mcg) 10 2 14 2 0 4

Vitamin C (mg) 47.9 41.8 69.7 2.5 47.7 6.9

Folate, DFE (mcg) 27 24 39 2 0 4

• USDA NDB codes: Oranges, raw, • 09200; Orange juice 100% fruit juice, • 09209; Apples, raw, 09003, Apple juice • 100% fruit juice with added ascorbic acid,

09400.

All fruits, and forms of fruit contribute to recommended fruit servings and nutrient adequacy On a per serving basis one small fruit, or ½ cup of whole fruit are consistent with ½ cup of 100% fruit juice

50

Replacing 100% fruit juice with whole fruit

results in lower intakes of important nutrients and insignificant fiber

increases


Replacing 100% fruit juice with whole fruit results in:

Lower intakes of vitamin C, folate and potassium Minor increases in Fiber

Drinking 100% Fruit Juice Does Not Negatively Affect Fiber Intake

52

Top Sources of Dietary Fiber in Food Supply

Fruits are a less effective means of increasing fiber intake – especially compared to foods like whole grain ready to eat cereal, beans, and popcorn

53

100% fruit juice consumption is

associated with higher whole fruit intake and

higher quality diets


• More vitamins and minerals

• More whole fruit • Lower intakes of fat,

saturated fat, and added sugars

• Milk and 100% fruit juice are complementary and not competitive in children’s diets

• Source of Phytonutrients

Children consuming 100% fruit juice

have better overall diet quality

Fruit Juice and Diet Quality of Children 55

Higher intake of whole fruit

Intake of Fruits and Vegetable may track into adolescence

and adulthood

Complimentary not competitive

100% Fruit Juice Intake is Associated with Increased Whole Fruit Intake

56

Majority of studies report that intake of 100% fruit

juice in appropriate amounts does not result in increased

weight and adiposity in children and adolescents


According to the 2010 Dietary Guidelines Advisory Committee Report, estimated consumption for 2-18 year

olds was about 100 calories per day from fruit juice

Juice accounts for only 8% of total caloric intake in the

diets of 2-18 year olds

100% Fruit Juice Provides Significant Nutrition and is Not a

Major Source of Calories in the Diets of Children

58

Positive Relationship

No / Inverse Relationship

Weight of Evidence

0 Based on nationally representative data

Where is the scientific weight of evidence for consumption of 100% fruit juice and weight in

children?

59

7 Based on nationally representative data

Evidence Analysis

“What is the association

between intake of 100% fruit juice and weight status

or adiposity in children?”

Comprehensive, systematic review of studies on 100% fruit

juice and weight studies in children and adolescents,

including an assessment of the quality of studies

The evidence reviewed does not

support an association between

100% fruit juice consumption and weight status or

adiposity in children ages 2 to 18 years

of age.

The Majority of Evidence Suggests that 100% Fruit Juice Does Not Impact Weight

in Children or Adolescents 60

100% fruit juice plays an important role in helping

American children meet the recommended fruit group

daily servings

100% fruit juice delivers significant nutrients in the

diets of children

Replacing 100% fruit juice with whole fruit results in lower intakes of important nutrients and insignificant

fiber increases

100% fruit juice consumption is associated

with higher whole fruit intake

and higher diet quality

Majority of studies report that intake of 100% fruit

juice in appropriate amounts does not result in increased

weight and adiposity in children and adolescents


62

• Contact Me: • Diane Welland, MS, RD • [email protected] • 202.207.1111 • www.juicecentral.org

Have questions or want

additional resources?

Thank You!

mailto:[email protected]

http://www.juicecentral.org/

Additional Resources 63

Beverage Study Type Sample Size Results 100% Fruit Juice Longitudinal (CARDIA) n=2,774 No association with high waist

circumference

100% Fruit Juice Cross sectional (NHANES)

n=14,196 Lower mean BMI and (NHANES) waist circumference in consumers vs non-consumers

Fruit Juice Cross sectional Canadian Community Health Survey

n=15,392 Inverse association with BMI

Fruit Juice Prospective cohort (Nurses’ Health Study I and II, Health Professional Follow-up Study)

n=120,877 Positive association with weight gain in each 4-year period

Fruit Juice Prospective cohort (Nurses’ Health Study I and II, Health Professional Follow-up Study)

n=124,988 Higher Intake associated with long term weight gain

Sample of Recent Studies on Adults and Juice Consumption

References: Duffey, 2010 Pereira and Fulgoni, 2010 Aktar-Danesh, 2010 Mozaffarian, 2011 Pan, 2013

64



Questions



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myplate: eat more fruit - school nutrition...–make half your plate fruits and vegetables. •...

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