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July 11, 2018

Be careful, pediatricians warn: Juice is a 'gateway beverage'

Daily Briefing

    Public health officials have been targeting sugary beverage consumption to reduce the United States' climbing obesity rates, but "for some reason" juice—which is high in sugar—has gotten "a pass," Erika Cheng, an assistant professor of pediatrics at Indiana University School of Medicine, and colleagues write in a New York Times op-ed.

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    The problem with juice

    American adults drink an average of 6.6 gallons of juice each year, and over 50% of preschool-age children drink juice regularly, largely because juice is wrongly associated with "healthfulness," Cheng, Lauren Fiechtner, an assistant professor of pediatrics at Harvard Medical School and the director of nutrition at MassGeneral Hospital for Children, and Aaron Carroll, a professor of pediatrics at Indiana University School of Medicine, write.

    The wrongful association is due in part to marketing by juice makers as well as federal nutrition guidelines, the authors write. U.S. Department of Agriculture guidelines state that individuals can get "up to half of fruit servings" from 100% juice. The guidelines also "recommend drinking fortified orange juice for the vitamin D," Cheng and colleagues add.

    However, the authors write, "Drinking fruit juice is not the same as eating whole fruit." They add, "Juices contain more concentrated sugar and calories. They also have less fiber, which makes you feel full."

    They note that a 12-ounce glass of orange juice has about the same amount of sugar as a can of Coke. The authors cite several studies that have linked "children's excessive consumption of juice ... to an increased risk of weight gain, shorter stature, and cavities." However, they write parents who view juice as a healthy option are often "unaware" of this relationship.

    The authors also point out that juice can be a "gateway beverage" that could lead children to drink more sugary beverages like soda.

    In summary, the authors argue for juice to be treated the same as any other sugary beverage, which are "fine to have periodically if you want them, but not because you need them."  Instead of giving children juice, parents should give children water and focus on having them eat whole fruit, the authors write. In addition, the authors urge schools and daycares to stop serving juice regularly and for public health efforts to "challenge government guidelines that equate fruit juice with whole fruit, because these guidelines most likely fuel the false perception that drinking fruit juice is good for health."

    The authors conclude, "In the past decade or so, we have succeeded in recognizing the harms of sugary beverages like soda. We can't keep pretending that juice is different" (Cheng, et. al., New York Times, 7/7).

    Get 16 action steps for improving patient access to nutrition-reinforced diets

    One in six households experience food insecurity, which means they have limited or uncertain access to nutritionally adequate and safe food. Individuals who are food insecure are two times as likely to suffer from diabetes and are three times as likely to have poor overall health status.

    When you consider these realities, you realize there is a largely untapped opportunity for providers to better serve the community while achieving population health objectives.

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