Does 100% fruit juice pose a health risk to kids akin to added-sugar drinks?

This is a summary of the findings of an HFA-commissioned survey of research into the health effects of 100% fruit juice, appearing in the April 2017 issue of Pediatriacs, the journal of the American Academy of Pediatrics. Read the article here.

Fruit Juice and Change in Body Mass Index: A Meta-Analysis


Executive summary

Authors: Brandon Auerbach, MD, MPH, Fred M. Wolf , PhD, Abigail Hikida, MD, Petra
Vallila-Buchman, MPH, Alyson Littman, PhD, MPH, Douglas Thompson, PhD, Diana
Louden, MLib, Daniel R. Taber, PhD, MPH, James Krieger, MD, MPH

The question of whether 100% fruit juice causes poor health outcomes in children,
such as weight gain, has been a subject of controversy. On one hand, 100% fruit juice
contains vitamins and nutrients that many children lack, is often cheaper than whole
fruit, and may help kids with limited access to healthy food meet their daily fruit

On the other, leading nutrition experts have expressed concern that fruit juice contains amounts of sugar equal to or greater than those of sugary drinks like regular soda. Guidelines from the American Academy of Pediatrics (AAP) and the Robert Wood Johnson Foundation’s Healthy Eating Research program warn that 100% juice can be a significant source of calories and contribute to obesity if consumed excessively.

Thus, they recommend that children should consume whole fruit instead of 100% fruit juice whenever possible. Since 2001, the AAP has recommended specific limits on how much 100% fruit juice children drink each day:

  • None until age 1;
  • No more than 4-6 ounces/day between ages 1 and 6 years; and
  • No more than 8-12 ounces per day between ages 7 and 18 years.

This study sought to answer the question, “Is consumption of one standard serving size of 100% fruit juice each day associated with weight gain in children?” Because there are no randomized controlled trials – the gold standard for nutrition studies – to provide evidence for juice recommendations for children, we undertook a systematic review and meta-analysis of existing research to synthesize the best available evidence. We systematically searched four scientific databases to answer this question and found eight studies – following a total of 34,470 children over time – and combined the results.We did not find strong evidence that one serving per day of 100% fruit juice was associated with weight gain. In children ages 1-6, consumption of one daily serving was independently associated with a weight gain of only 0.08-0.15 kg (0.18-0.33 pounds) over one year. In children ages 7-18, 100% fruit juice was not independently associated with any weight gain.

The conclusions of this survey have limitations. Although we combined evidence from the best available research, the studies were not randomized controlled trials. Randomized controlled trials are the most trustworthy level of scientific evidence, and sometimes contradict conclusions from non-experimental studies like those in our meta-analysis. We did not examine other important health outcomes besides weight gain, such as diabetes risk, because too few studies exist on this topic in children. Two recent studies of children ages 1-3 (included in this meta-analysis) found clinically significant amounts of weight gain in this age group from one serving a day, and it may be possible that this age group is at higher risk for weight gain from drinking 100% fruit juice than older children.

More research should examine whether children under age 3 are at higher risk of weight gain from drinking 100% fruit juice. Randomized controlled trials examining the effect of 100% fruit juice consumption on metabolic and health outcomes, including weight gain, are needed in children 1-6. Our results support current recommendations from the American Academy of Pediatrics’ and Robert Wood Johnson’s Healthy Eating Research program that children ages 1-6 limit 100% fruit juice to 4-6 ounces per day and children ages 7-18 limit juice to 8-12 ounces a day.<

This study does not resolve the debate about the health effects of 100% fruit juice among children. However, our study provides evidence that children may drink 100% fruit juice in moderation, and that the existing recommendations on daily limits are prudent.




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  • published this page in Publications 2017-03-22 14:07:38 -0700

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