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Copyright © 2013 School Nutrition Association. All Rights Reserved.
www.schoolnutrition.org
Check your audio connection to be sure your speakers are on and the volume is up.
Archive recording, presentation slides, resources, and CEU form are available at:
www.schoolnutrition.org/webinars
Welcome!
facebook.com/SchoolNutritionAssociation @SchoolLunch
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Copyright © 2013 School Nutrition Association. All Rights Reserved.
www.schoolnutrition.org
100% Juice – Truth vs. Pulp Fiction
Wednesday, November 5, 2014
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Copyright © 2013 School Nutrition Association. All Rights Reserved.
www.schoolnutrition.org
Today’s Moderator
Nadia Egziabher Child Nutrition and Policy Coordinator
School Nutrition Association
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Copyright © 2013 School Nutrition Association. All Rights Reserved.
www.schoolnutrition.org
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
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Copyright © 2013 School Nutrition Association. All Rights Reserved.
www.schoolnutrition.org
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
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100% Fruit Juice Truth vs Pulp Fiction
6
Nov 2014
Diane Welland M.S., R.D. Manager of Nutrition
Communications Juice Products Association
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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
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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
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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)
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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
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• 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
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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.
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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.
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• 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
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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
$/1000 kcal
What foods provide maximum calories per dollar?
Food price and quality
What foods provide maximum nutrients per calorie and per
dollar?
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What is energy density? Water content
0 100 200 300 400 500 600 700 800 900
Oil
Animal fat
Salty snacks
Deli meat
Pastries
Sugar
Cheese
Meat mixed dishes
Fatty fish
Meat
Poultry
Eggs
Whole grains
Refined grains
Fish
Shellfish
Dairy products
Fruit
Milk
SSB
Fruit juices
Veg mixed dishes
Vegetables
Tap water
ED (kcal/100g)
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0
100
200
300
400
500
600
700
800
900
0.1 1 10 100Energy cost ($/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
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0
100
200
300
400
500
600
700
800
900
0.1 1 10 100Energy cost ($/1000 kcal)
Ener
gy d
ensi
ty (k
cal/1
00g)
Dairy Meat Eggs Beans
Log scale
nuts
eggs
shellfish
fish
Lower cost
Higher cost
beans
meat
yogurt
Meat and fish cost more per kcal Data from USDA FNDDS 1.0 and CNPP prices database
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0
100
200
300
400
500
600
700
800
900
0.1 1 10 100Energy cost ($/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
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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
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Do healthier diets cost more?
Key question
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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
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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.
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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
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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
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-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
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-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
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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
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SES gradient also in HEI 2010 scores (2009-10 NHANES) Rehm et al (under review)
Quintiles of diet cost
Whole fruit
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• 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
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Who is most likely to eat whole fruit?
Key question
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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
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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
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0
0.25
0.5
0.75
1
1.25
1.5
<1.3 1.3-3.5 >3.5
100% juiceWhole fruit
Age group (y)
Poor people eat less total fruit Se
rvin
gs
More poor Less poor
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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
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0
0.25
0.5
0.75
1
1.25
1.5
<High School High School Some college College
100% juiceWhole fruit
College graduates (>25y) eat more total fruit Se
rvin
gs
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0
0.25
0.5
0.75
1
1.25
1.5
Mexican American Other Hispanc NH White NH Black
100% juiceWhole fruit
Minorities eat more total fruit and 100%juice Se
rvin
gs
NH Whites eat least total fruit !!!!
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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
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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
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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
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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
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• 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
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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)
Observed (95% CI) Model 1 (95% CI)
Model 2 (95% CI)
Model 1 = fruit; Model 2 = fruit and 100% juice
More potassium; more vitamin C (model 2)
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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)
Observed (95% CI) Model 1 (95% CI)
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)
Observed (95% CI) Model 1 (95% CI)
Model 2 (95% CI)
Modeling to meet recommendations. Ages 4-13y (n=1071)
Model 1 = fruit; Model 2 = fruit and 100% juice
More fiber (model 1); more calcium (model 2)
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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)
Observed (95% CI) Model 1 (95% CI)
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)
Observed (95% CI) Model 1 (95% CI)
Model 2 (95% CI)
Modeling to meet recommendations. Ages 4-13y (n=1071)
Same dietary energy; not higher cost (model 2)
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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.
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• Combination of fruit and 100% fruit juice provides a cost neutral way of meeting the widespread fruit shortfall.
Conclusion
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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
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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
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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
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Replacing 100% fruit juice with whole fruit
results in lower intakes of important nutrients and insignificant fiber
increases
Facts About 100% Fruit Juice 51
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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
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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
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100% fruit juice consumption is
associated with higher whole fruit intake and
higher quality diets
Facts About 100% Fruit Juice 54
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• 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
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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
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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
Facts About 100% Fruit Juice 57
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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
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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
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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
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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
Facts About 100% Fruit Juice 61
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62
• Contact Me: • Diane Welland, MS, RD • [email protected] • 202.207.1111 • www.juicecentral.org
Have questions or want
additional resources?
Thank You!
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Additional Resources 63
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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
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www.schoolnutrition.org
Questions
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www.schoolnutrition.org
Thank You Archives, CEU information, and other resources available at www.schoolnutrition.org/webinars