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The role of fruit juice in the diet: an overview
H. Caswell
British Nutrition Foundation, High Holborn House, London, UK
Summary
Over recent years, consumers have shown an increasing interest in health and
wellbeing, with many wanting food and drink products that are healthy and
nutritious, yet fit in with busy lifestyles. Fruit juice is one beverage that has seen a
dramatic increase in consumer purchasing since the 1970s, and is now consumed by
nearly half the UK population. While the beneficial effects of consuming diets rich
in fruit and vegetables are well documented, the specific health effects of consuming
fruit juice are less so. Further, the role of fruit juice in conditions such as obesity has
also recently come under scrutiny, due to questions over how liquid calories affect
subsequent energy intake. Limitations in the literature in this area include a lack of
studies looking at different types of fruit juices and their effects on health, as well
as studies that differentiate fruit juice from fruit and vegetable intake. Consuming
a diet rich in fruit and vegetables (to which fruit juice can count once towards the
5 A DAY target) can help to reduce an individual’s risk of suffering from a variety
of chronic diseases, and should therefore be encouraged.
Keywords: fruit juice, juice drinks, CVD, dental caries, 5 A DAY
Introduction
Fruit juice is a popular choice of beverage, and the fruit
juice market is one that has grown substantially over
recent years (Mintel 2009). Indeed, recent research
indicates that the market for fruit juice and juice drinks
increased by 37% between 1999 and 2004, reaching
£2.32 billion, with volume increasing by 26% over the
same period to around 2.2 billion litres per year
(Mintel 2009). Its rise in popularity may be due in part
to an increase in interest in health and nutrition
amongst consumers, but also to the fact that the everexpanding fruit juice market now provides a range of
different juice varieties catering for all tastes and needs
(Mintel 2009).
This review will begin by looking at the many different juice products available to consumers, before
Correspondence: Heather Caswell, Nutrition Scientist, British
Nutrition Foundation, High Holborn House, 52-54 High Holborn,
London, WC1V 6RQ, UK.
E-mail: [email protected]
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
looking at the role of juice in a balanced diet and its
nutritional properties. The amount of fruit juice currently being consumed in the UK, and its contribution to
nutrient intakes, will then be discussed. A summary of
recent research into the impact of fruit juice consumption on health, both potential benefits and detrimental
effects, will also be given. Finally, the environmental
impact of juice production will briefly be considered.
Juice
Juice is a popular beverage amongst consumers, seen by
many as a ‘healthy’ option, which is also ‘natural’
(Mintel 2008) and appeals to the busy individual
wanting an easy way to get one of their 5 A DAY (see
NHS 2009a).
While the juice market is one that is ever expanding, broadly speaking, juice can be divided into two
categories:
(1) Fruit juice
(2) Juice drinks
273
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H. Caswell
Fruit juice
Fruit juice is a drink consisting of 100% pure fruit juice,
which typically contains no preservatives or other added
ingredients [British Soft Drinks Association (BSDA
2009)]. Fruit juices can be classified as:
product spoilage, and products typically have a shelf life
of 2–6 weeks. However, as with longer-life products,
once opened, these beverages must be consumed within
the period stated on pack.
Juice drinks
Freshly squeezed
Freshly squeezed juices are produced by ‘squeezing’ the
juice from the fruit of choice, which is then packaged
and transported to the retailer usually within 24 hours.
These juices often do not undergo any form of pasteurisation (see further discussion) and therefore typically
have a very short shelf life (2–3 days) (BSDA 2009).
However, they may undergo high-pressure treatment
and/or modified-atmosphere packaging to increase their
shelf life.
From concentrate
In the case of juices ‘from concentrate’, the juice is
extracted from the fruit in exactly the same way as
described previously. However, the extracted fruit juice
is then concentrated (by evaporating the water naturally
present in the juice) (BSDA 2009). This concentrate is
often frozen before being transported to its destination,
where water is added back to reconstitute the juice to
100% fruit juice (or alternatively, it can be used as an
ingredient in a cordial/squash drink).
During production, fruit juices from concentrate are
typically heat-treated, to ensure that any unwanted
spoilage pathogens, including bacteria or moulds, are
destroyed. The type of heat treatment the juice is subjected to affects the shelf life of the product:
Long-life products These products are pasteurised by
exposing them to a temperature of approximately
90°C for a short time period (10–20 seconds). They
are then packaged into sterilised containers where the
air is removed, so the products remain sterile. These
products have a shelf life of approximately 6–9
months, but once opened must be stored in a chilled
environment and consumed within the stated period of
a few days. These products may be referred to as
‘ambient products’, as they do not require refrigeration
during storage.
Short-life/chilled products A lower temperature (70–
75°C) is used in the pasteurisation of chilled products,
which are again heat-treated for approximately 10–20
seconds. Refrigeration is required to reduce the risk of
Juice drinks are products which contain anything less
than 100% pure fruit juice. The level of fruit juice
contained in these drinks can be found in the ingredients
panel, usually on the back of the pack. In reality, there
are a vast range of products with differing percentages
of fruit juice. These drinks may include those that are
purchased in a ready-to-drink format, or those that are
purchased as ‘cordial’, also known as dilutable drinks.
These require dilution prior to consumption, and are
typically diluted with approximately four parts water to
one part cordial. Dilutable products may include products made with sugar, as well as low sugar options made
with sweeteners.
A relatively new addition to this area is ‘high juice’
juice drinks. These products contain a higher percentage
of juice than most other juice drinks, with products
currently available containing up to 70% fruit juice.
Other juice options
Nectars
Although not commonly consumed in the UK, fruit
nectars are popular in many parts of Europe. Fruit juice
nectars are defined as the fermentable but unfermented
product obtained by the addition of water and sugar to
fruit juice, concentrated fruit juice, fruit purée or concentrated fruit purée (or a mixture of these) (Jukes
1997). They typically consist of less than 100%, but
more than 20%, fruit juice. In the US, the term nectar is
one that is used for a diluted juice to denote a beverage
that contains fruit juice or purée and water, and which
may contain sweeteners (FDA 2009). These products
will not be discussed further in this review.
Smoothies
Fruit smoothies are typically combinations of
homogenised/crushed fruit and juice. Most single servings of commercially available fruit smoothies (typically
250 ml) contain at least one 80 g portion of whole fruit,
as well as one portion of fruit juice (150 ml). Until
very recently, despite the higher fruit content of many
smoothies when compared to more traditional fruit
juice products, they were still considered to only provide
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
The role of fruit juice in the diet
one serving of the 5 A DAY fruit and vegetable target
(see further discussion). However, the Department of
Health has recently revised this advice, which now states
that any smoothie that contains at least 150 ml of fruit
juice and at least 80 g of crushed fruit (or vegetable)
pulp can claim up to a maximum of two portions of the
5 A DAY recommendation (NHS 2009b). Because of the
difference between smoothies and fruit juice in terms of
their nutritional properties and possible health benefits,
smoothies are not covered in detail in this review,
although they are touched upon briefly throughout. For
a more in-depth overview of the potential health benefits
of smoothies and their role in the diet, see Ruxton
(2008).
275
for taste, but are increasingly focused upon health and
‘naturalness’ (Reuters 2008).
As is suggested previously, this expansion has now
moved beyond simply providing different flavours and
types of juices, to providing juices enriched with vitamins and/or minerals, as well as various different
‘functional’ ingredients. Further, many drinks are now
targeted at specific audiences, with a particular focus
in recent years for a move towards providing ‘adult
soft drink’ alternatives to alcohol. Indeed, this sector is
one of the fastest growing sectors of the drinks
market, driven by a preference for healthier drinks,
changing attitudes towards alcohol consumption and a
willingness to pay more for this type of product
(Mintel 2006).
Fruit juices with added ingredients
In addition to the more traditional fruit juice and juice
drink varieties mentioned above, in recent years the fruit
juice market has also seen the introduction of more
‘functional’ fruit juice products (‘functional foods being
those that encompass potentially healthful products that
may provide a health benefit beyond that provided by
the traditional nutrients it contains’) with added ingredients. Some examples include: 100% orange juice fortified with plant sterols. Plant sterols are plant-derived
cholesterol-lowering substances that have for some time
been added to dairy foods (e.g. yogurts and yogurt
drinks) and spreads (see Caswell et al. 2008). Also,
orange juice enriched with longer-chain omega-3 fatty
acids, docosahexeanoic acid (DHA) and eicosapentaenoic acid (EPA), naturally found in oily fish with
proven health benefits. While this is one section of the
fruit juice market that will no doubt increase over the
coming years, the specific role/benefits of these products
will not be discussed further in this review.
Market trends in fruit juice consumption
The fruit juice market is one that has grown substantially over the past 20–30 years, and this is reflected by
a substantial increase in consumption (DEFRA 2007,
2009). In 2008, the fruit juice market was worth an
estimated £3.2 billion (Mintel 2008). While the more
traditional flavours of orange and apple juice still dominate the market (over 70%), consumer demand for ever
more exotic flavours has seen the market diverge rapidly
from its early beginnings in the 1970s (Mintel 2009).
While products such as cranberry juice began to emerge
during the early 1990s (The Grocer 1997), today new
flavours are constantly being introduced. These beverages are not only targeted to satisfy consumer demand
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
The role of fruit juice in a balanced diet
While the variety of different juice options presented
above means a greater choice for consumers, it also
represents a possible source of confusion as to the health
benefits of the different types of drink on offer. For
example, it may be particularly problematic trying to
decide which count towards the government’s 5 A DAY
target, and which do not. It is therefore important that
consumers can understand and correctly interpret the
vast array of juice products available, so as to make an
informed choice when selecting a juice product.
It is important to note that this review only discusses
fruit juice and fruit juice drinks, and therefore no reference has been made to vegetable juices. However, these
can also make a useful contribution to nutrient intakes,
offer health benefits and count towards the 5 A DAY
target.
A healthy balanced diet
Consuming a healthy, balanced diet is essential for
general health, maintaining a healthy body weight and
reducing the risk of a range of conditions, including
heart disease, stroke, cancer, diabetes and osteoporosis
(BNF 2007).
What is a healthy diet?
A healthy diet is one that is based on breads, rice,
potatoes, pasta and other starchy foods, and is rich in
fruits and vegetables. It will also include moderate
amounts of milk and dairy foods, meat, fish, eggs, beans
and other sources of non-dairy protein, and limited
amounts of foods and drinks high in fat and/or sugar.
Eating a variety of different foods is essential, as no one
276
H. Caswell
food can provide the body with all the nutrients it needs
(BNF 2007).
In terms of fruit and vegetables, the UK Department
of Health (DH) recommends that everyone should try
to consume at least five servings of fruit of vegetables a
day (5 A DAY), to help reduce the risk of diseases such
as coronary heart disease and cancer (DH 2007). A
portion of fruit or vegetables is approximately 80 g,
which is, for example, one apple, a medium banana,
three heaped tablespoons of cooked vegetables (e.g.
peas, sweet corn) or two satsumas. For children, these
portions will be slightly smaller, being approximately
40–60 g (or alternatively, what fits into the palm of a
child’s hand). It is important to remember that variety
is essential, and we should aim to eat five different
servings each day. In addition to fresh fruit, frozen,
canned and dried also count, as does fruit juice. Indeed,
in the 5 A DAY guidance, the Department of Health
states that a 150 ml serving of fruit (or vegetable) juice
counts as one portion. However, only one serving of
juice per day can count, irrespective of how much is
consumed. This is due to the fact that fruit juice contains very little fibre, even the freshly squeezed varieties
and those containing ‘juicy bits’ (see Table 1). Further,
the juicing process frees the sugars that are present
naturally in fruit, which means that drinking juice frequently between meals may be damaging to teeth (DH
2007). Currently in the UK, the average intake of fruits
and vegetables combined is just 2.8 portions per day
(Henderson & Gregory 2002), and there is therefore an
urgent need for the majority of people to increase their
consumption. For those people who do not do so
already, having fruit juice daily can help to achieve the
5 A DAY target.
Most countries around the world promote the importance of eating more fruit and vegetables (see Painter
et al. 2002), but the detail of the message varies. For
example, New Zealand focuses on the importance of
eating a variety of fruit and vegetables, with the message
‘eat your colours everyday – 5+ a day the colour way’
(5+ a day 2009). In the US, recommendations on fruit
and vegetable intake are based upon the age, sex and
physical activity levels of an individual, and recommendations are given as cup sizes, rather than portion sizes
(http://www.mypyramid.gov).
The nutrient composition of fruit juice
The information presented in Table 1 allows for comparison of the nutritional profile of different fruit
juice/juice drink varieties. One of the most striking
observations relates to freshly squeezed fruit juice and
fruit juice ‘from concentrate’. It is a common consumer (mis-) perception that 100% freshly squeezed
juice varieties are healthier than ‘from concentrate’
products (Reuters 2008). However, from the data presented, it can be seen that there is actually little difference in terms of nutritional value between the two.
The chilled/freshly squeezed products presented have
similar energy, sugar and fibre concentrations to the
concentrated varieties, and both count towards an
individual’s 5 A DAY. It would, however, be interesting
to see if any difference exists between these products in
terms of other nutritional components, such as antioxidants and phytochemicals, an area where research
is currently lacking.
As can also be seen from Table 1, the energy content
of fruit juices and juice drinks varies quite widely,
ranging from the lower energy (artificially sweetened)
cordial drinks (providing 1.8 kcal/100 ml) to the relatively high energy fruit juices and juice drinks. An
average 200 ml serving of fruit juice (the suggested
on-pack serving size) would provide approximately
100 kcal of energy, similar to the amount provided by
some non-juice beverages, such as semi-skimmed milk
or cola (Table 2), but considerably more than unsweetened tea or coffee. The relatively high energy content of
fruit juice (derived from sugars naturally present in the
fruit) may be one reason why fruit juice consumption
has been linked with concerns over weight gain.
However, as discussed more fully later, a recent review
of the evidence has concluded that 100% fruit juice
consumption does not appear to be associated with
weight status or the likelihood of being overweight in
childhood (O’Neil & Nicklas 2008).
The sugar content of fruit juice and juice drinks is
also variable. Food labelling legislation requires a declaration of total sugars content on pack, but in the UK
there is no dietary reference value for total sugars
intake. However, a reference value of no more than
10% of total energy (E) intake does exist for non-milk
extrinsic sugars (NMES). NMES refers to those sugars
that are not part of the cellular structure of foods, or
those that are added to foods during processing or
preparation (DH 1991). The definition includes the
phrase ‘non-milk’, as sugars found in milk (e.g. lactose)
are extrinsic, but are not included as part of this 10%
total energy recommendation. Using the estimated
daily energy requirement of women (2000 kcal) as a
guide, this translates to approximately 50 g/day of
NMES (DH 1991). Using similar principles, the Institute of Grocery Distribution (IGD) has suggested a
Guideline Daily Amount (GDA) value for total sugars
for labelling purposes of 90 g/day (IGD 2005). Average
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
100% freshly squeezed orange juice (not from concentrate) –
chilled product
Pure orange juice from concentrate, unsweetened (ready to
drink) – ambient product
Pure orange juice from concentrate with bits – ambient
product
Pure pineapple juice from concentrate – ambient product
Carbonated apple juice from concentrate (100%) – ambient
product
100% pure squeezed orange and mango juice – chilled product
Orange and mango juice drink (70% pressed juice and 30%
sparkling water)
Cranberry juice drink (25% cranberry juice from concentrate)
– ambient product
Concentrated blackcurrant juice drink (contains 22% juice).
Requires dilution prior to consumption (values given for juice
after dilution using 30 ml of cordial, as diluted with 1 part
cordial: 4 parts water)
Blackcurrant squash from concentrate (10%). No added sugar,
contains sweeteners. Requires dilution prior to consumption
(values given for juice after dilution using 30 mL of cordial, as
diluted with 1 part cordial: 4 parts water)
Still orange juice drink from concentrate (12%) (ready to drink)
Orange and mango juice drink (ready to drink, fruit juice from
concentrate – orange (12.4%), lemon (5.4%), passion fruit
(1.5%), mango puree (0.7%).
Mango and Passion fruit smoothie
15
17
18
14
13
17
16
0.4
16
15
70
77
74
68
57
74
69
3
65
67
19
16
70
84
14
Total sugars (g)
69
Energy (kcal)
(EAR = 1940 kcal/day
(women), 2550 kcal/day
(men))
Source: figures are based on averages of manufacturers data.
ND: data not available.
EAR (Estimated Average Requirement): the average amount of energy required by UK adults.
RNI (Reference Nutrient Intake): the amount of a nutrient that is enough to meet the needs of the majority of the population.
NB – all figures are approximates, and may vary depending upon the different brands of products.
Smoothies
Fruit juice drinks
Fruit juice
Table 1 Nutritional information for juice, per 150 ml as consumed
3
0
0
0
ND
Trace
0.75
0.75
0
Trace
0
0
0.4
Fibre (NSP) (g)
(RNI = 18 g/day)
56
ND
24
ND
45 (vitamin C
added to juice)
60 (vitamin C
added to cordial)
30
ND
ND
ND
41
38
40
Vitamin C (mg)
(RNI = 40 mg/day)
✓
X
X
X
X
x
✓
x
✓
✓
✓
✓
✓
Count as one
of 5 A DAY?
The role of fruit juice in the diet
277
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H. Caswell
Table 2 Nutritional information for non-fruit juice beverages, per 150 ml as consumed
Semi-skimmed milk
Water
Lemonade
Cola
Tea, infusion, made with semi-skimmed milk
Coffee, instant, made with water and semi-skimmed milk
Energy (kcal)
Sugar (g)
Fibre (g)
Vitamin C (mg)
69
0
33
62
11
11
6.6
0
9
16
1
1
0
0
0
0
0
0
1.5
0
0
0
0
0
Source: FSA (2006).
intakes of NMES currently exceed the 10% energy
level and intakes are particularly high in a number of
population groups, for example young adults (aged
19–24 years) and children (Gregory & Lowe 2000;
Henderson & Gregory 2002). In fresh fruit, the sugars
present are contained within the cell structure (intrinsic
sugars); however, the juicing process releases these
sugars and so they are categorised as non-milk extrinsic
sugars (NMES). It is therefore assumed, when discussing the sugar content of fruit juice, that 100%
of the sugars present contribute towards NMES
intake.
Fruit juices and juice products also contain vitamin
C, unlike many non-juice beverages, and therefore can
be considered as a good vehicle through which to
ensure individuals are getting a sufficient amount of
this nutrient. However, it is interesting to note the
wide variation in the vitamin C content of various
juices. From the data presented earlier, it can be seen
that orange juice provides the most naturally occurring
vitamin C out of all the products listed, with both the
freshly squeezed and ‘from concentrated’ products providing a similar amount. While cranberry juice drink is
also a good source of vitamin C, it must be noted that
vitamin C has been added to this product during production, and therefore this high level is not solely
because of the vitamin C present naturally in the
product. However, studies that have assessed the bioavailability of vitamin C from natural versus synthetic
sources seem to indicate no differences in absorption
between the two (Nelson et al. 1975; Mangels et al.
1993). Consumers can therefore be confident of
getting similar benefits in terms of vitamin C content
from drinking such a product compared to consuming
a product naturally containing vitamin C. In contrast
to this, juice drink products provide substantially less
vitamin C, highlighting the need for consumers to read
the labels of juice products, to select the one that best
meets their needs.
Further, the data show that fruit juice and juice drinks
provide very little, if any, dietary fibre. Dietary fibre is
the non-digestible part of plant foods, which is found
naturally in a variety of foods including fruits, vegetables, cereals and pulses. Fibre comprises a range of
substances with overlapping properties (Buttriss &
Stokes 2008), one of which is cholesterol reduction, and
high fibre intakes (especially so-called soluble or viscous
types of fibre) can therefore help protect against heart
disease. Fibre is also important for normal bowel functioning. The recommended daily intake in the UK for
adults is 18 g of dietary fibre when measured by the
Englyst method [which measures the non-starch
polysaccharides (NSP) content of food stuffs]. However,
most UK adults fail to reach this target, with a national
average of just 15.2 g per day for men and 12.6 g for
women (Henderson & Gregory 2002). The figures presented in Table 1 documenting the low fibre levels found
in most fruit juice drinks support the guidelines set by
the Department of Health, that fruit juice should only
count once towards the 5’A DAY target, and highlight
the fact that fruit juice should not be seen as a dietary
substitute for fresh fruit. Of note is the higher amount of
fibre provided by smoothies, which is due to the fact
that, unlike fruit juice, smoothies contain crushed fruit
and/or vegetables (Ruxton 2008).
As shown in Table 1, 150 ml of fruit juice (including
carbonated varieties) counts once towards the 5 A
DAY target. Further, some ‘high juice’ juice drinks may
also count, provided enough of the juice is consumed
(e.g. a serving of 220 ml of 70% juice would count as
one of the 5 A DAY). While the majority of cordials
and juice drinks do not count towards this target, they
still provide a similar amount of energy to fruit juice,
as well as a similar amount of sugar. It is for this
reason that many healthy eating guidelines state that,
if individuals consume fruit juice-based beverages,
they should try to opt for 100% juice varieties (Byers
et al. 2002).
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
The role of fruit juice in the diet
Fruit juice in the UK diet
How much is being consumed?
National food surveys have been carried out in the
UK since the 1940s and give an indication of the types
and quantities of foods being consumed by UK households each year. The quantity of fruit juice purchased
in UK households from 1975 to present is shown in
Figure 1.
As can be seen from this data, there was a large
increase in the purchasing of fruit juice between 1975
and the early 1990s, when purchasing increased nearly
eightfold. However, since the mid to late 1990s, fruit
juice purchases have largely plateaued. Although there
does not appear to be any one reason for this lack of
expansion of the market, it has been speculated that
competition from alternative beverages may be one
cause (The Grocer 2001), and that extending consumption beyond breakfast has proved challenging (Mintel
2008). The vast array of different juice drink products
currently available on the market also means that
increasing the consumption of pure fruit juices remains
difficult for manufacturers (Mintel 2008). It must be
noted that currently, data from the National Food
Survey of UK household food purchases is only available until 2007; it would be interesting to see if juice
purchasing, particularly of the more luxury items, has
suffered in the recent economic climate. Recent data
seem to suggest that this may indeed be the case (see
Fig. 2, Nielsen 2009). It would also be interesting to
see the impact that these changes have had upon
nutrient intakes of the population, particularly vitamin
C intake.
The National Diet and Nutrition survey is a rolling
dietary survey that gathers information about the diets
and nutritional status of the UK population. Data from
this survey can be used to identify the percentage of the
UK population who consume fruit juice, as well as the
mean amount of juice they consume. It can also be used
to identify the percentage contribution of fruit juice to
nutrient intakes of different population sub-groups. As
can be seen in Table 3, fruit juice appears to be a
popular choice of beverage among young people and
adults, with nearly half of both men and women from
these age groups reporting consuming fruit juice. While
approximately one third of young children and older
women consume juice, only 12% of older adult men
reported consuming fruit juice. In terms of the amount
of fruit juice consumed, young people reported consuming the most, at an average of 903 ml/week (boys) and
825 ml/week (girls). When looking at the information
presented in Figure 1 and Table 3, it is important to note
that the data presented in Figure 1 is based on an
average of all the households sampled in the survey, and
therefore may take into account households who never
Quantity of fruit juice purchased in UK
households (ml per person per week)
400
350
300
250
200
150
100
50
0
1975 1990 1996- 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2006 2007
1997 1998 1999 2000 2001 2002 2003 2004 2005
Year
Figure 1 Changes in the amount of fruit juice purchased in the UK (ml per person per week) from 1975 to 2007.
Data source: National Food Survey; Expenditure and Food Survey (DEFRA 2007, 2009).
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
279
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H. Caswell
Percentage year on year change in value sales of various types of
drinks
5.00
2.53
Percentage change
0.00
1
-1.26
-5.00
-3.52
-4.20
-10.00
-8.12
-8.57
-10.59
-15.00
-20.00
-25.00
-30.00
-35.00
-34.77
-40.00
Smoothies Ambient
Smoothies Chilled
100% Juice Chilled
100% Juice Ambient
Non-Pure Juice Ambient
Non-Pure Juice Chilled
Bottled Water
SQUASH
Figure 2 Percentage change in sales of a selection of beverages, including fruit juice, smoothies and dilutable cordials, from May 2008 to May 2009.
Data from Nielsen (2009).
Table 3 Mean consumption of fruit juice (ml per week) by those classed as fruit juice consumers, and the percentage of the total
population classed as consumers
Children* aged 11⁄2 to 41⁄2
Males
Females
Young people† (aged 41⁄2 to 18)
Adults‡ (aged 19–64)
Older adults§ (aged 65–74)
Mean intake
(ml/week)
% of
sub-group
Mean intake
(ml/week)
% of
sub-group
Mean intake
(ml/week)
% of
sub-group
Mean intake
(ml/week)
% of
sub-group
759
832
35
36
903
825
46
51
877
767
43
47
526
701
12%
34%
*Gregory et al. (1995).
†
Gregory and Lowe (2000).
‡
Henderson and Gregory (2002).
§
Finch et al. (1998).
purchase juice. Further, this data reflects purchases,
rather than actual consumption, and it cannot be guaranteed that all the juice purchased was consumed. In
contrast, the NDNS data in Table 3 comes from
weighed food diaries of fruit juice consumers, and therefore gives a more accurate indication of how much fruit
juice people who drink juice are actually consuming.
Although there are limitations with such surveys, such
as misreporting of food intakes (see Macdiarmid &
Blundell 1998), these figures are some of the most accurate currently available for the UK population.
Contribution to nutrient intakes in the
UK population
Carbohydrate (including fructose and glucose) is the
main macronutrient in fruit juice. Fruit juice also contains a wide variety of micronutrients, most notably
vitamin C, but also folate, beta carotene, potassium and
polyphenols (O’Neil & Nicklas 2008). Table 4 shows
the contribution of 100% fruit juice to a selection
of nutrient intakes in the UK population, based on the
current level of consumption.
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
The role of fruit juice in the diet
281
Table 4 Percentage contribution of fruit juice to nutrient intakes in the UK population
Males
Females
Age
Vitamin C
Fibre
Sugars (NMES)
Energy (MJ)
Vitamin C
Fibre
Sugars (NMES)
Energy (MJ)
11⁄2–41⁄2*
4–6†
7–10†
11–14†
15–18†
19–24‡
25–34‡
35–49‡
50–64‡
65+§
8.6
18
19
22
26
24
17
22
19
12
0
0
0
0
0
0
0
0
0
0
3.1
6
6
5
6
3
4
6
7
3
ND
1
1
1
1
1
1
1
1
*
10.4
20
19
23
26
24
21
17
16
14
0
0
0
0
0
0
0
0
0
0
3.6
7
7
6
8
7
8
7
9
5
ND
1
1
1
1
1
1
1
1
*
*Gregory et al. (1995).
†
Gregory and Lowe (2000).
‡
Henderson and Gregory (2002).
§
Finch et al. (1998).
*Values less than 0.5%.
NB – volumes based on current levels of consumption, as shown in Table 3. Figures based on the percentage contribution to nutrient intakes of the whole
population.
1 MJ = 239 kcal.
As shown in Table 4, fruit juice makes a significant
contribution to the vitamin C intakes of both men and
women of all ages, but most notably older teenagers
(15–18 years of age). It is of interest that today, fruits,
vegetables and fruit juices are the main dietary sources
of vitamin C. However, during the war period, when
fruit was in short supply and fruit juice was, to all
extents and purposes, non-existent, potatoes were in
fact the main vitamin C source in the diet. However,
once rationing ceased, potato consumption decreased,
and consumption of fruit, as well as fruit juice, rose,
bringing average vitamin C intakes up from 51 mg/day
in 1940 to 59 mg/day in 2000 (data from NFS). In
addition to vitamin C, it must be noted that fruit juice
also contributes to population intakes of other vitamins,
including folate, although this contribution is a lot less
than the contribution to vitamin C intakes (NDNS
data).
While fruit juice can be seen to be a beneficial addition to the diet, it does not contribute to the fibre
intakes of the population at any age, owing to the very
small amounts of fibre present, even in the freshly
squeezed varieties (see Table 1). While the data presented in Tables 1 and 2 suggest that, when compared
to non-soft drink options, such as water and milk, fruit
juice is relatively high in sugar, its contribution to total
NMES intake in the diet is fairly low. As the data show,
at a population level, it appears that, on average, less
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
than 10% of NMES intake in all age groups comes
from fruit juice. This suggests that concerns about its
high sugar content contributing to population NMES
intake may be unjustified, as it appears that the majority of NMES intake at all ages come from other dietary
sources. In terms of concerns over the high energy
content of fruit juice, when compared to other drinks,
it can be seen that it is providing on average just 1% of
energy intake in adults, and less than 0.5% in the older
adults age group.
Fruit juice and health
This section provides an overview of evidence from
studies investigating the impact of fruit juice on health.
This overview was compiled by examining published
studies identified from databases such as PubMed. It is
in no way a systematic review of the evidence, but
provides a summary of recent research conducted in this
area.
It is widely recognised that fruit and vegetable consumption is associated with good health. Although the
precise reasons for this still elude researchers, the health
benefits provided by these foods are largely thought to
stem from their micronutrient content, and also plant
bioactives. Plant bioactives or phytochemicals are nonnutritive constituents of plant foods with anticipated
health-promoting/beneficial effects (Margetts & Buttriss
282
H. Caswell
2003; Gry et al. 2007). These compounds include carotenoids, flavonoids and other phenolic compounds that
have been suggested to play a role in protecting against
conditions such as cardiovascular disease (CVD) and
cancer (Visioli et al. 2000; Johnson 2007). Initially it
was assumed that the mechanisms underpinning these
effects were related to the antioxidant properties of such
bioactive substances and the antioxidant nutrients (e.g.
vitamin C) available in these foods, but it is now recognised that the mechanisms are more complex than this
[see Jackson (2003) for a detailed overview]. The healthpromoting effects of fruits and vegetables are probably
due to a variety of factors, such as the low energy
density of these foods.
The bulk of the available literature on the health
effects of plant foods concerns fruits and vegetables per
se, but some information is also available for juices.
Outlined below is a summary of the literature describing
the health effects of consuming fruit juice.
Associations between juice consumption and
healthier dietary habits
Many of the studies looking at the health benefits of
fruit juice consumption focus on its ability to promote
a better nutrient intake in consumers versus nonconsumers, and indicate that people who consume fruit
juice tend to have healthier overall dietary habits than
those who do not. In one such study, fruit juice consumption and total nutrient intake was assessed in a
cohort of 3618 children aged 2–11 years. The study
found that, compared to those children who did not
consume fruit juice, those who consumed more than
170 ml of fruit juice daily had significantly higher
intakes of total carbohydrate, vitamins C and B6, folate,
potassium, magnesium and iron, and significantly lower
intakes of total and saturated fat and added sugar. The
children also consumed significantly more servings of
fruit and vegetables compared to non-juice consumers
(Nicklas et al. 2008). However, the study failed to
report any association with socio-economic status, and
did not report if this confounder was controlled for,
highlighting a potential drawback in the methodology.
This association between juice consumption and healthy
lifestyle habits has also been observed by Schulz et al.
(2005), who identified better weight control in adults
consuming fruit juice (although it was not stated if this
was 100% juice) as part of a diet that was also rich in
wholegrain bread, fruits and raw vegetables, and lower
in high-fat foods. This supports previous findings suggesting fruit juice consumption is a marker of healthier
dietary habits.
Obesity
Some studies have highlighted possible detrimental
effects associated with fruit juice consumption, such as a
possible increase in risk of obesity and short stature in
children who consume juice. For example, in a crosssectional study involving a US cohort of 168 healthy
children aged 2 (n = 94) and 5 (n = 74) years, consumption of 340 ml per day of fruit juice was found to be
associated with obesity (Dennison et al. 1997).
However, it must be noted that this amount of juice both
far exceeds that recommended as counting towards the
5 A DAY target (150 ml), and average consumption in
the UK (Table 3).
In recent years, there has been interest in the potential
effect that energy consumed as so-called ‘liquid calories’
has on weight control, with suggestions that energy
from liquids is less satiating then energy from solids (see
Benelam 2009). This interest has stemmed from the
observation that an increase in the consumption of
sugared beverages parallels the rising obesity levels seen
in many countries. The theory behind the association
between weight gain and beverage consumption is that
sugar-containing beverages are less satiating than solid
foods providing the same amount of energy, and hence
can lead to over-consumption of energy compared to
needs (DiMeglio & Mattes 2000). The WHO technical
report on diet and chronic disease (2003) specifically
noted that the energy contained in fluids was not well
detected by the body, such that energy compensation
(the adjustment of energy intakes provoked by the ingestion of a given food stimulus) at subsequent eating occasions does not occur (WHO 2003). However, evidence
to support this is inconsistent and it may actually be the
mode of consumption (i.e. whether the liquid is perceived to be a food or drink) that influences its effect on
satiety [see Benelam (2009) for an overview].
Evidence looking specifically at the role of fruit juice
and juice drinks on weight control has produced seemingly conflicting results (see Drewnowski & Bellisle
2007 for a summary). In one recent study, O’Neil and
Nicklas (2008) reviewed the current evidence on the
impact of fruit juice consumption on weight gain. The
review considered the results from nine cross-sectional
and 12 longitudinal studies that had all assessed the
relationship between 100% fruit juice consumption
and weight control in children and adolescents. These
studies varied in size, with many being large-scale
(involving 3000+ participants). The different studies
also comprised a range of ages of children (2 to 19
years). The study concluded that, based on current evidence, 100% fruit juice consumption was associated
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
The role of fruit juice in the diet
with better nutrient intake but was not associated with
weight status or the likelihood of being overweight in
childhood. Many studies have also considered the
impact of sugar-sweetened beverages, including fruit
juice drinks, on weight gain. In one study of 136 Australian children, intake of cordial at age 7.7 years was
found to be associated with an increase in Body Mass
Index (BMI) at a mean age of 13 years (Tam et al.
2006). However, it must be noted that no information
was given as to whether possible confounders were controlled for in this study. In contrast, a secondary analysis
of data from the National Health and Nutrition Examination Survey 1999–2002 (a study that was included in
the review by O’Neil and Nicklas (2008), but which also
looked at fruit juice drinks as well as fruit juice), found
no association between fruit juice intake and weight.
This analysis assessed the impact of fruit juice intake,
including 100% juice varieties as well as juice drinks
(defined as any sweetened fruit juice, fruit-flavoured
drink, or drink that contained fruit juice in part) of 1572
2–5-year-old children on BMI. No association was
found between BMI and 100% fruit juice consumption,
or with intake of fruit juice drinks (O’Connor et al.
2006).
Although there is currently much debate as to the
impact of intrinsic versus added sugars in this context, it
should be noted that the nutrition and energy content of
different sugars is identical (i.e. 3.75 kcal/g).
CVD and cancer
The protective effects of consuming fruit and vegetables
on CVD and cancer risk are well documented (see
Margetts & Buttriss 2003; Stanner et al. 2004). Evidence in this area has come from large-scale cohorts
followed over many years. For example, Bazzano et al.
(2002) found subjects who consumed more than three
servings of fruit and vegetables per day had a 42%
reduction in stroke mortality and a 27% reduction in
risk of CVD mortality compared to those who consumed less than one serving per day. In a meta-analysis
of cohort studies, Dauchet et al. (2006) reported that
the risk of coronary heart disease (CHD) is reduced by
4% for each additional serving of fruit and vegetable per
day and by 7% for fruit intake. In terms of fruit and
vegetables and cancer risk, a large review conducted in
the early 1990s found that fruits and vegetables had a
significant protective effect against a variety of forms of
cancer (Block et al. 1992). Furthermore, the World
Cancer Research Fund/American Institute for Cancer
Research expert report on diet and cancer concluded
that vegetables and fruits may protect against a range of
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
283
cancers including mouth, stomach and bowel cancer,
leading the report to recommend that people should try
to eat more (WCRF/AICR 2007).
More specifically, the benefits of consuming fruit juice
on CVD and cancer risk have also been described. In a
review looking at the potential role played by fruit juice
in preventing these conditions, Ruxton et al. (2006)
searched MEDLINE and the Cochrane library for
studies which assessed the impact of consumption of
pure fruit juice on CVD and cancer. Evidence was
assessed from 37 studies relating to fruit juice consumption and CVD, ranging in size from small-scale studies
with ten participants to large-scale cohorts, such as the
Nurses Health Study (over 71 000 participants), and
including studies with both healthy subjects and participants with health problems (e.g. hypertension, impaired
glucose tolerance). To assess the effects of fruit juice on
cancer, 11 studies were examined, which looked at outcomes such as breast cancer risk, risk of renal cell
carcinoma, and DNA damage. The review found convincing evidence from epidemiological and clinical
studies that pure fruit juice reduces CHD risk via a
number of probable mechanisms; however evidence
documenting the protective effect of fruit juice on cancer
risk was not as strong (Ruxton et al. 2006).
A further intervention study has shown a reduction
in oxidative cell damage (involved in the pathogenesis
of atherosclerosis, cancer and diabetes) and an increase
in blood glutathione levels (an antioxidant) after consumption of mixed red berry juice (Weisel et al. 2006).
In this study, 18 male subjects and 9 controls consumed
700 ml of either mixed berry juice or a corresponding
polyphenol-depleted juice, respectively, on a daily basis
for a four-week period. Subjects consuming the juice
saw a decrease in oxidative DNA damage (P < 0.0005)
and an increase in glutathione status (P < 0.05) when
compared with controls. Finally, fruit juice consumption, specifically citrus fruit juices, has also been associated with protection against ischemic stroke (RR 0.75
for an increment of one serving per day) in a very large
cohort involving over 100 000 subjects from the Nurses’
Health Study and the Health Professional’s Study
(Joshipura et al. 1999).
Health effects of specific fruit juices
Despite the fact that there are many different varieties of
fruit juices available, there is actually relatively little
difference between them in terms of the nutrients they
provide (Table 1). However, plant bioactive composition and profile can vary greatly between fruits, due
partly to the wide variety of colours, a direct result of
284
H. Caswell
some of these components, such as carotenoids and
anthocyanins (Saltmarsh et al. 2003). The available evidence which describes the potential benefits of certain
different types of fruit juice is summarised below.
Cranberry juice has long been associated with the
treatment of urinary tract infections (UTIs). A recent
Cochrane review looked at the effectiveness of cranberry juice in preventing UTIs in susceptible populations
(including infants, pregnant women and the elderly).
The review found cranberry juice may decrease the
number of symptomatic UTIs over a 12-month period,
particularly in those women with recurrent UTIs
(Jepson & Craig 2008). Despite this, the European Food
Safety Authority (EFSA), which is currently reviewing
potential health claims to be allowed on food and drink
products, recently rejected an application for the use of
a claim supporting the role of cranberry juice in reducing the risk of UTIs in women (specifically by inhibition
of the adhesion of certain bacteria in the urinary tract).The panel concluded that the evidence provided in
support of this claim was not sufficient to allow such an
on-pack health claim to be made (EFSA 2009).
Frequent consumption of grape juice (rich in a
variety of flavanoids) has been associated with
improved endothelial function within the lining of
blood vessels. In a study investigating the effect of consuming purple grape juice on endothelial function in
15 patients with coronary artery disease, it was shown
that consumption of juice for 14 days improved flowmediated vasodilation and reduced LDL-susceptibility
to oxidation (Stein et al. 1999). Further studies have
also shown grape juice consumption to reduce platelet
aggregation (associated with atherosclerotic disease
development) (Keevil et al. 2000; Freedman et al.
2001), although it must be noted that both of these
trials used small numbers (10 and 20 subjects respectively) of healthy subjects.
The effects upon health of blackcurrant juice have
also been studied. In a group of 48 patients with peripheral artery disease, a daily combination of blackcurrant
juice and orange juice (250 ml of each) was shown to
reduce markers of inflammation, when compared with
subjects who were given a reference beverage with a
similar amount of carbohydrate but no bioactive components (Dalgard et al. 2009).
While there are some suggestions in the literature that
specific fruit juices may have roles in promoting health,
the evidence to demonstrate the underpinning mechanisms is largely absent. Vitamin C, present in citrus
juices and those from berries in particular, is often
recommended in the popular press as helping to banish
cold and flu symptoms. However, a recent Cochrane
review assessed the available evidence of the role of
vitamin C supplementation (at doses of at least 200 mg
per day or more) on symptoms of the common cold.
Contrary to popular belief, evidence from 30 different
studies, involving a total of 11 350 participants, showed
that regular supplementation with vitamin C had no
effect on the incidence of cold symptoms in the general
population, although it may reduce the severity and
intensity of common cold symptoms slightly. However,
the magnitude of this effect was so small that its clinical
usefulness is doubtful. Despite this, it may have a beneficial role for those under conditions of extreme physical or cold stress (such as marathon runners or skiers)
(Hemilä et al. 2007). However, it must be kept in mind
that it has repeatedly been shown that the results of
supplement trials of specific nutrients are often not comparable to the effects shown when physiological levels of
a nutrient are consumed via the diet. One of the reasons
for this is likely to be because foods and drinks (e.g.
juices) contain many additional components not found
in a supplement. The detailed effects of most of these
compounds on health are still not known, and there is
also the possibility that they may interact in a positive
manner with nutrients such as vitamin C at levels available in foods.
Dental health
Dental caries (tooth decay) are caused by the progressive
destruction of the teeth by acid produced by bacteria on
the tooth surface. These bacteria produce acid by fermenting sugars found in foods, which decreases the pH
at the tooth surface and causes demineralisation of the
tooth enamel. Over time, these acids are gradually neutralised by saliva, and when the pH of the mouth rises to
its original level, remineralisation of the tooth occurs
using calcium and other minerals present in saliva.
When food and drinks containing sugar are consumed
frequently throughout the day, there is little time for this
remineralisation process to occur, and tooth decay
results.
As stated, the sugar in fruit juice and juice drinks is
present as NMES, and therefore fruit juice and juice
drinks have a much greater cariogenic potential than
whole fruits, which are not associated with the production of dental caries (Moynihan & Petersen 2004).
Of particular concern with regards to the cariogenic
potential of fruit juices are situations where young
children are given juices in bottles or sip cups, causing
the juice to be in contact with the teeth for a prolonged period of time. Current evidence indicates
that a high frequency of sugar consumption is more
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
The role of fruit juice in the diet
damaging in terms of caries development than the total
amount of sugar consumed at any one time (Moynihan
2005), so this practise is thought to be associated with
an increase in caries risk (Tinanoff & Palmer 2000). A
number of studies have examined the impact of fruit
juice and juice drinks on tooth decay. For example, the
association between dental caries and beverage consumption was assessed in a cohort of 642 US children
who were tracked in a longitudinal study from the
ages of 1–7 years. The authors found that consumption of fruit juice was associated with increased caries
risk; however, the effect of fruit juice on caries risk
was not as great as that seen with other beverages,
such as soda (Marshall et al. 2003). This finding is
also supported by a recent study by Lim et al. (2008).
In this study, the cariogenicity of soft drinks, compared to water and fruit juice, was tested in a cohort
of over 350 3–5 year olds. They found that children
who consumed more soft drinks, relative to milk and
fruit juice, were at a greater risk of developing dental
caries as they grew older.
To help reduce the risk of suffering from dental caries,
while also benefiting from the health benefits offered by
fruit juices, the British Dental Health Foundation suggests that people should try and consume fruit juice at
meal times, or if consuming juice between meal times, to
dilute it with water. Further, brushing teeth after consuming acidic foods or drinks (such as fruit juice) can
cause permanent damage to teeth due to erosion of the
tooth enamel. It is therefore advised to either brush teeth
before a meal, to allow the fluoride in toothpaste to coat
the teeth and protect them; or alternatively to wait until
an hour after eating or drinking acidic foods before
brushing, in order for the saliva in the mouth to
have time to neutralise the acids (British Dental Health
Foundation 2005).
Environmental impact of fruit juice
Fruit juices are a popular choice of drink among health
conscious consumers, offering an easy and quick way to
get one of their 5 A DAY. However, with consumers
demanding ever more exotic flavours, which they often
expect to be ‘fresh’ at the time of purchase, the environmental impact of this industry must be considered. The
type of juice (i.e. concentrate versus fresh), as well as the
flavour, both play a role in the impact that juice production has on the environment.
As already stated, juices ‘from concentrate’ are produced by evaporating the water from the extracted fruit
juice in the place of production (British Soft Drinks
Association 2009). Once these juices have been made
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
285
into a concentrate, they can be frozen and shipped to
their destination, where they are then reconstituted. In
comparison, consumer demand for freshly squeezed
juice means these products often must reach stores
within a day of being pulped, and therefore air travel is
required. As air travel has the greater impact on carbon
dioxide emissions, opting for these fresh juices could be
seen as a less environmentally friendly option. Further,
concentrated juices can be more efficiently transported
than fresh varieties, due to their very nature (i.e. there is
less liquid to transport). In addition to these factors,
another consideration is that fresh juice requires transportation via a chilled distribution chain, right from the
point of production to the point of purchase. Once at
the point of purchase, it again also requires chilling by
the retail outlet and again in the home prior to consumption. This is in contrast to concentrated varieties,
which can usually be stored at ambient temperatures
once packaged until opened. All these factors can be
seen to impact upon an individuals ‘carbon footprint’,
which specifically relates to the amount of greenhouse
gases produced in our day-to-day lives through burning
fossil fuels for e.g. electricity, as well as processes such as
food production (Carbon Footprint 2009). This has lead
to heightened interest over recent years in trying to
reduce the carbon footprint of the diet, both by thinking
about the transportation method of foods, while also
considering the foods we eat on a daily basis (Science
Daily 2008).
In addition to the impact of fresh versus concentrated
juice, the type of fruit juice also has an impact on the
environment. Orange juice has traditionally been the
most popular flavour of fruit juice, and to this day
remains one of the most common choices amongst consumers (BBC 2005). While this option may not be seen
as particularly exotic, the two largest producers of
orange juice are Brazil and Florida, whose combined
production accounts for 90% of the world’s supply
(FAO 2009). Further, as more exotic flavours are
brought to the fruit juice market to satisfy consumer
thirst for premium drinks, e.g. pomegranate, the need
for juice to be transported by air from a variety of
locations around the world will no doubt increase. The
environmentally conscious consumer may therefore
wish to opt for juices produced closer to home to minimise the impact that this is having on the environment.
It is, however, appreciated that this may be difficult,
with some manufacturers failing to include such information on their products. Further, where claims such as
‘produced in the UK’ are made on-pack, this can simply
mean that the final product has been made in the UK,
and does not necessarily mean that all the ingredients
286
H. Caswell
are from the UK. While manufacturers who state such
information on pack are required to ensure this information is accurate, to prevent misleading consumers
(FSA 2009), it appears that actually identifying the
source of all the ingredients used to produce a product is
difficult, and suggests that further regulations may be
needed to allow consumers to make environmentally
friendly purchases.
Conclusions
As can be seen from the information presented above,
fruit juice can have a place in a healthy, balanced diet,
both in terms of providing individuals with one serving
of their recommended 5 A DAY, as well as making an
important contribution to vitamin C intakes. In addition
to fruit juice, new juice drinks are now also emerging
with enhanced nutritional properties, including products with added ingredients as well as ‘healthier’ fruit
juice drinks (e.g. high juice drinks). Consuming a diet
rich in fruits and vegetables, to which fruit juice can
contribute one serving, as part of a healthy balanced diet
may also help to reduce the risk of suffering from a
variety of chronic diseases, including cardiovascular
disease and cancer.
While the market for fruit juice continues to expand,
providing consumers with a vast array of juice products
to choose from, it is important that consumers can
understand the varying nutritional properties that the
different varieties may provide, and opt for the healthier
choices. Looking at the evidence presented here, it can
be seen that 100% fruit juice varieties provide the most
natural vitamin C, and are favourable compared with
many juice drink varieties, which can often contain the
same amount of energy and sugar, but do not count as
one of the 5 A DAY. This observation is reflected in the
American Cancer Society Guidelines on Nutrition and
Physical Activity for Cancer Prevention, which recommend that individuals should always opt for 100% juice
if they consume fruit or vegetable juices (Byers et al.
2002). Further, despite the common consumer misconception that freshly squeezed varieties of 100% juice
are healthier than those ‘from concentrate’, this does not
actually appear to be the case. In the current economic
climate, this may therefore provide consumers with a
cheaper, more environmentally friendly option to help
them achieve one of their 5 A DAY.
Finally, while fruit juice consumption may be a useful
way to help the population consume more fruit and
achieve sufficient vitamin C intakes, it must be remembered that fruit juices, unlike fresh fruit, do not contribute to fibre intakes, and are also a source of NMES.
Consumption must therefore not be to the detriment of
fresh varieties of fruit and vegetables, but rather as an
additional way to ensure the consumption of a healthy,
balanced diet. Further, the frequency of intake between
meals should also be limited.
Conflict of interest
The Foundation has received financial support from
GlaxoSmithKline in the production of this review.
However, the views expressed are independent and
GlaxoSmithKline have not been involved in writing or
shaping the contents of this paper.
References
5+ a day (2009) Available at: http://www.5aday.co.nz/
cms_resources/Colour%20Way%20Brochure.pdf (accessed June
2009).
Bazzano LA, He J, Ogden LG et al. (2002) Fruit and vegetable
intake and risk of cardiovascular disease in US adults: the first
National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. American Journal of Clinical Nutrition
76: 93–9.
BBC (2005) Warning over fruit juice excess. Available at: http://
news.bbc.co.uk/1/hi/health/4208823.stm (accessed January 2009).
Benelam B (2009) Satiation, satiety and their effects on eating
behaviour. Nutrition Bulletin 34: 122–69.
Block G, Patterson B & Subar A (1992) Fruit, vegetables and
cancer prevention: a review of the epidemiological evidence.
Nutrition and Cancer 18(1): 1–29.
BNF (British Nutrition Foundation) (2007) Healthy eating: a whole
diet approach. Available at: http://www.nutrition.org.uk/home.
asp?siteId=43&sectionId=325&subSectionId=320&parentSection=
299&which=1 (accessed April 2009).
British Dental Health Foundation (2005) Diet. Available at: http://
www.dentalhealth.org.uk/faqs/leafletdetail.php?LeafletID=14
(accessed January 2009).
British Soft Drinks Association (2009) Fruit juice. Available at:
http://www.britishsoftdrinks.com/default.aspx?page=394 (accessed
January 2009).
Buttriss JL & Stokes C (2008) Dietary fibre and health: an overview. Nutrition Bulletin 33: 186–200.
Byers T, Nestle M, McTiernan A et al. (2002) American Cancer
Society Guidelines on Nutrition and Physical Activity for Cancer
Prevention. Reducing the risk of cancer with healthy food choices
and physical activity. CA: A Cancer Journal for Clinicians 52:
92–119.
Carbon Footprint (2009) What is a carbon footprint? Available at:
http://www.carbonfootprint.com/carbonfootprint.html (accessed
April 2009).
Caswell H, Denny A & Lunn J (2008) Plant stanol and sterol
esters. Nutrition Bulletin 33: 368–73.
Dalgard C, Nielsen F, Morrow JD et al. (2009) Supplementation
with orange and blackcurrant juice, but not vitamin E, improves
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
The role of fruit juice in the diet
inflammatory markers in patients with peripheral arterial disease.
British Journal of Nutrition 101: 263–9.
Dauchet L, Amouyel P, Hercberg S et al. (2006) Fruit and vegetable
consumption and risk of coronary heart disease: a meta-analysis
of cohort studies. Journal of Nutrition 136: 2588–93.
DEFRA (Department for Environment, Food and Rural Affairs)
(2007) National food survey – datasets. Available at: https://
statistics.defra.gov.uk/esg/publications/nfs/default.asp (accessed
February 2009).
DEFRA (Department for Environment, Food and Rural Affairs)
(2009) Family food – report on the expenditure and food survey.
Available at: https://statistics.defra.gov.uk/esg/publications/efs/
default.asp (accessed February 2009).
Dennison BA, Rockwell HL & Baker SL (1997) Excess fruit juice
consumption by preschool-aged children is associated with short
stature and obesity. Pediatrics 99: 15–22.
DH (Department of Health) (1991) Dietary Reference Values, A
Guide. HMSO: London.
DH (Department of Health) (2007) 5 a day portion information.
Available at: http://www.dh.gov.uk/en/Publichealth/
Healthimprovement/FiveADay/FiveADaygeneralinformation/
DH_4001494 (accessed January 2009).
DiMeglio DP & Mattes RD (2000) Liquid versus solid carbohydrate: effects on food intake and body weight. International
Journal of Obesity and Related Metabolic Disorders 24: 794–
800.
Drewnowski A & Bellisle F (2007) Liquid calories, sugar and
body weight. American Journal of Clinical Nutrition 85:
651–61.
EFSA (European Food Safety Authority) (2009) Article 14 health
claims, opinions. Available at: http://www.efsa.europa.eu/EFSA/
efsa_locale-1178620753812_1211902333214.htm (accessed
03/2009).
FAO (Food and Agriculture Organization of the United Nations)
(2009) Citrus juice production and fresh market extension technologies. Available at: http://www.fao.org/docrep/003/x6732e/
x6732e08.htm (accessed February 2009).
FDA (US Food and Drug Administration) (2009) Guidance for
industry: the juice HACCP regulation – questions and answers.
Available at: http://www.fda.gov/Food/
GuidanceComplianceRegulatoryInformation/GuidanceDocuments/
Juice/ucm072602.htm (accessed June 2009).
Finch S, Doyle W, Lowe C et al. (1998) National Diet and Nutrition Survey: People Aged 65 Years and over. The Stationary
Office: London.
Freedman JE, Parker C, Li L et al. (2001) Select flavonoids and
whole juice from purple grapes inhibit platelet function and
enhance nitric oxide release. Circulation 103: 2792–8.
FSA (Food Standards Agency) (2006) McCance and Widdowsons’
The Composition of Foods, Sixth Summary Edition. Royal
Society of Chemistry: Cambridge.
FSA (Food Standards Agency) (2009) Understanding labeling rules.
Available at: http://www.food.gov.uk/foodlabelling/ull/ (accessed
April 2009).
Gregory JR & Lowe S (2000) National Diet and Nutrition Survey:
Young People Aged 4 to 18 Years. The Stationary Office: London.
Gregory JR, Collins DL, Davies PSW et al. (1995) National Diet
and Nutrition Survey: Children Aged 11⁄2 to 41⁄2Years. The
Stationary Office: London.
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288
287
Gry J, Black L, Eriksen FD et al. (2007) EuroFIR-BASIS – a
combined composition and biological activity database for bioactive compounds in plant-based food. Trends in Food Science and
Technology 18: 434–44.
Hemilä H, Chalker E, Treacy B et al. (2007) Vitamin C for preventing and treating the common cold. Cochrane Database of
Systematic Reviews 3: CD000980.
Henderson L & Gregory J (2002) National Diet & Nutrition
Survey: Adults Aged 19 to 64 Years. The Stationary Office:
London.
IGD (Institute of Grocery Distribution) (2005) GDA Working
Group Report. Report of IGD/PIC Industry Group, Nutrition.
Strategy Group, Technical Working Group on Guideline Daily
Amounts (GDAs). IGD: Herts.
Jackson M (2003) Potential mechanisms of action of bioactive substances found. In: Plants: Diet and Health. The Report of the
British Nutrition Foundation Task Force, (G Goldberg ed.),
pp. 65–75. Blackwell Publishing: Oxford.
Jepson RG & Craig JC (2008) Cranberries for preventing
urinary tract infections (Review). Cochrane Reviews: CD001321.
Johnson IT (2007) Phytochemicals and cancer. Proceedings of the
Nutrition Society 66: 207–15.
Joshipura KJ, Ascherio A, Manson JE et al. (1999) Fruit and vegetable intake in relation to risk of ischemic stroke. Journal of the
American Medical Association 282: 1233–9.
Jukes DJ (1997) Food Legislation of the UK: A Concise Guide, 4th
Revised edition. Butterworth-Heinemann Ltd: London.
Keevil JG, Osman HE, Reed JD et al. (2000) Grape juice, but not
orange juice or grapefruit juice, inhibits human platelet aggregation. Journal of Nutrition 130: 53–6.
Lim S, Sohn W, Burt BA et al. (2008) Cariogenicity of soft drinks,
milk and fruit juice in low-income African-American children.
Journal of the American Dental Association 139: 959–67.
Macdiarmid J & Blundell J (1998) Assessing dietary intake: who,
what and why of under-reporting. Nutrition Research Reviews
11: 231–53.
Mangels AR, Block G, Frey CM et al. (1993) The bioavailability to
humans of ascorbic acid from oranges, orange juice and cooked
broccoli is similar to that of synthetic ascorbic acid. The Journal
of Nutrition 123: 1054–61.
Margetts B & Buttriss JL (2003) Epidemiology linking consumption
of plants foods and their constituents with health. In: Plants: Diet
and Health. The Report of the British Nutrition Foundation Task
Force, (G Goldberg ed.), pp. 49–64. Blackwell Publishing:
Oxford.
Marshall TA, Levy SM & Broffitt B (2003) Dental caries and beverage consumption in young children. Pediatrics 112: 184–91.
Mintel (2006) Adult soft drinks – UK. Report outline available at:
http://reports.mintel.com/sinatra/reports/index/letter=1/display/
id=173695 (accessed April 2009).
Mintel (2008) Fruit juice and juice drinks – UK. Available at: http://
oxygen.mintel.com/sinatra/oxygen/display/id=227778 (accessed
Jan 2009).
Mintel (2009) The fruit juice market: an appealing squeeze.
Available at: http://www.marketresearchworld.net/
index.php?option=com_content&task=view&id=484&
Itemid=48 (accessed February 2009).
Moynihan PJ (2005) The interrelationship between diet and oral
health. Proceedings of the Nutrition Society 64: 571–80.
288
H. Caswell
Moynihan PJ & Petersen PE (2004) Diet, nutrition and the
prevention of dental diseases. Public Health Nutrition 1A:
201–26.
NHS (National Health Service) (2009a) 5-a-day. Available at: http://
www.5aday.nhs.uk/topTips/default.html (accessed April 2009).
NHS (2009b) Media Centre: 7th April 2009 – 5 A DAY POLICY
UPDATE. Available at: http://www.5aday.nhs.uk/topTips/
media_centre.html (accessed May 2009).
Nelson EW, Steiff RR & Cerda JJ (1975) Comparative bioavailability of folate and vitamin C from a synthetic and a natural source.
American Journal of Clinical Nutrition 28: 1014–19.
Nicklas TA, O’Neil CE & Kleinman R (2008) Association between
100% juice consumption and nutrient intake and weight of children aged 2 to 11 years. Archives of Pediatric and Adolescent
Medicine 162: 557–65.
Nielsen AC (2009) Data to Week End 16.05.09.
O’Connor TM, Yang S & Nicklas TA (2006) Beverage intake
among preschool children and its effect on weight status. Pediatrics 118: e1010–e1018.
O’Neil CE & Nicklas TA (2008) A review of the relationship
between 100% fruit juice consumption and weight in children
and adolescents. American Journal of Lifestyle Medicine 2:
315–54.
Painter J, Rah J-H & Lee Y-K (2002) Comparison of international
food guide pictorial representations. Journal of the American
Dietetic Association 102: 483–9.
Reuters (2008) Detailed in-depth analysis of the UK soft drinks
markets for 2008. Available at: http://www.reuters.com/article/
pressRelease/idUS68938+03-Jul-2008+BW20080703 (accessed
February 2008).
Ruxton CHS (2008) Smoothies: one portion or two? Nutrition
Bulletin 33: 129–32.
Ruxton CHS, Gardner EJ & Walker D (2006) Can pure fruit and
vegetable juices protect against cancer and cardiovascular disease
too? A review of the evidence. International Journal of Food
Sciences and Nutrition 57: 249–72.
Saltmarsh M, Crozier A & Ratcliffe B (2003) Fruit and vegetables.
In: Plants: Diet and Health. The Report of the British Nutrition
Foundation Task Force, (G Goldberg ed.), pp. 107–33. Blackwell
Publishing: Oxford.
Schulz M, Nothlings U, Hoffman K et al. (2005) Identification of
food pattern characterized by high-fibre and low-fat food choices
associated with low prospective weight change in the EPICpotsdam cohort. The American Society for Nutritional Sciences
Journal of Nutrition 135: 1183–9.
Science Daily (2008) Want to reduce your food-related carbon footprint? What you eat is more important than where it came from.
Available at: http://www.sciencedaily.com/releases/2008/04/
080421161338.htm (accessed April 2009).
Stanner S, Hughes J, Kelly CNM et al. (2004) A review of the
epidemiological evidence for the ‘antioxidant hypothesis. Public
Health Nutrition 7: 407–22.
Stein JH, Keevil JG, Wiebe DA et al. (1999) Purple grape juice
improves endothelial function and reduces the susceptibility of
LDL cholesterol to oxidation in patients with coronary artery
disease. Circulation 100: 1050–5.
Tam CS, Garnetti SP & Cowell CT (2006) Soft drink consumption
and excess weight gain in Australian school students: results
from the Nepean study. International Journal of Obesity 30:
1091–3.
The Grocer (1997) Feeling the big squeeze. Issue: 01/11/1997.
The Grocer (2001) The Grocer focus on juice and juice drinks.
Issue: 07/04/2001.
Tinanoff N & Palmer CA (2000) Dietary determinants of dental
caries and dietary recommendations for preschool children.
Journal of Public Health Dentistry 60: 197–206.
Visioli F, Borsani L & Galli C (2000) Diet and prevention of
coronary heart disease: the potential role of phytochemicals.
Cardiovascular Research 47: 419–25.
WCRF/AICR (World Cancer Research Fund/American Institute for
Cancer Research) (2007) Food, Nutrition, Physical Activity,
and the Prevention of Cancer: A Global Perspective. AICR:
Washington, DC.
Weisel T, Baum M, Eisenbrand G et al. (2006) An anthocyanin/
polyphenolic-rich fruit juice reduces oxidative DNA damage and
increases gluthathione levels in healthy probands. Biotechnology
Journal 1: 388–97.
WHO (World Health Organization) (2003) Diet, Nutrition and the
Prevention of Chronic Disease. Report of a joint WHO/FAO
Expert Consultation. WHO Technical Report Series 916. WHO:
Geneva.
© 2009 The Author
Journal compilation © 2009 British Nutrition Foundation Nutrition Bulletin, 34, 273–288