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May 2012

Potential Nutritional and Economic Effects of Replacing Juice With Fruit in the Diets of Children in the United States

Author Affiliations

Author Affiliations: School of Public Health, University of Washington, Seattle (Dr Monsivais and Mr Rehm); and UK Clinical Research Collaboration Centre for Diet and Activity Research, Cambridge, England (Dr Monsivais).

Arch Pediatr Adolesc Med. 2012;166(5):459-464. doi:10.1001/archpediatrics.2011.1599

Objective To estimate the nutritional and economic effects of substituting whole fruit for juice in the diets of children in the United States.

Design Secondary analyses using the 2001-2004 National Health and Nutrition Examination Survey and a national food prices database. Energy intakes, nutrient intakes, and diet costs were estimated before and after fruit juices were completely replaced with fruit in 3 models that emphasized fruits that were fresh, inexpensive, and widely consumed and in a fourth model that partially replaced juice with fruit, capping juice at recommended levels.

Setting A nationwide, representative sample of children in the United States.

Participants A total of 7023 children aged 3 to 18 years.

Main Exposures Systematic complete or partial replacement of juice with fruit.

Main Outcome Measures Difference in energy intakes, nutrient intakes, and diet costs between observed and modeled diets.

Results For children who consumed juice, replacement of all juice servings with fresh, whole fruit led to a projected reduction in dietary energy of 233 kJ/d (−2.6% difference [95% CI, −5.1% to −0.1%]), an increase in fiber of 4.3 g/d (31.1% difference [95% CI, 26.4%-35.9%]), and an increase in diet cost of $0.54/d (13.3% difference [95% CI, 8.8%-17.8%]).

Conclusions Substitution of juice with fresh fruit has the potential to reduce energy intake and improve the adequacy of fiber intake in children's diets. This would likely increase costs for schools, childcare providers, and families. These cost effects could be minimized by selecting processed fruits, but fewer nutritional gains would be achieved.