Pure 100% fruit juices – more than just a source of free sugars? A review of the evidence of their effect on risk of cardiovascular disease, type 2 diabetes and obesity

Pure 100% fruit juices – more than just a source of free sugars? A review of the evidence of their effect on risk of cardiovascular disease, type 2 diabetes and obesity. Carrie H. S. Ruxton, Emma Derbyshire, John L. Sievenpiper. Nutrition Bulletin, November 17 2021. https://doi.org/10.1111/nbu.12526

Abstract: Pure 100% fruit juice (100%FJ) provides a source of nutrients and bioactive substances, such as flavonoids, carotenoids and pectin, and counts as a serving of fruit in several countries. Nevertheless, 100%FJ has been the subject of debate since it also contains free sugars and provides less fibre than whole fruits. Sugar recommendations, when translated into policy, are designed to limit population consumption of free sugars. The World Health Organization (WHO) free sugars classification does not differentiate between added sugars and free sugars naturally occurring in 100%FJ and other foods. Hence, there is an implication that all sources of free sugars are equally detrimental and should be reduced. But is this the case? Since WHO’s original 2003 classification, a considerable amount of evidence has been published on 100%FJ and its impact on health. This paper provides an update, focussing on meta-analyses where available. These show protective associations for cardiovascular health at intakes of up to 200 ml/day, and significant improvements in vascular function, blood pressure and inflammation at higher intakes. Evidence on obesity, metabolic markers and type 2 diabetes risk – where studies have clearly differentiated consumption data for 100%FJ – suggests no clinically significant negative impact of 100%FJ at a wide range of intakes, unless diets are in positive energy balance. Data on nutrient adequacy from observational studies indicate positive associations between 100%FJ and intakes of whole fruits, vitamin C, vitamin A, folate and potassium. Since the evidence does not appear to show that drinking moderate amounts of 100%FJ is harmful to metabolic health or weight management, free sugars reduction policies should focus on sources that represent a genuine health risk and make a negligible contribution to nutrient adequacy. 100%FJ at intakes of up to 150 ml/day and consumed at mealtimes to protect dental health should remain part of 5 A DAY advice.