Abstract
Total fruit intake in the United States is ~1 cup equivalent per day, or one-half of the 2010 Dietary Guidelines for Americans recommendation for adults. Two-thirds of the fruit consumed is whole fruit and one-third is 100% juice. The nutritional value of whole fruit, with the exception of fiber and vitamin C, may be retained with appropriate juice production methods and storage conditions. One-hundred percent fruit juice consumption is associated with a number of health benefits, such as improved cardiovascular health and decreased obesity, although some of these and other potential benefits are controversial. Comprehensive analyses of the evidence by the Academy of Nutrition and Dietetics in 2014, the US Dietary Guidelines Advisory Committee in 2010, and the Australian Dietary Guidelines of 2013 concluded that 100% fruit juice is not related to adiposity in children when consumed in appropriate amounts for age and energy needs. However, some reports suggest the consumption of fruit juice contributes to unhealthful outcomes, particularly among children. A dietary modeling study on the best ways to meet the fruit intake shortfall showed that a combination of whole fruit and 100% juice improved dietary density of potassium and vitamin C without significantly increasing total calories. Notably, 100% juice intake was capped at amounts consistent with the 2001 American Pediatric Association guidance. The preponderance of evidence supports the position that 100% fruit juice delivers essential nutrients and phytonutrients, provides year-round access to a variety of fruits, and is a cost-effective way to help people meet fruit recommendations.
Keywords: dietary guidelines, phytochemicals, fruit, nutrition, juice, 100% juice
Introduction
The 2010 Dietary Guidelines for Americans recommend that Americans consume more fruits and vegetables (1). MyPlate translates the message as, “Make half your plate fruits and vegetables,” and specifies 1–2 cups (the units of measure are based on the US Dietary Guidelines, which do not include metric) of fruit per day depending on age, gender, and physical activity level (2). Although in the past fruits and vegetables were often counted together, both for education and in dietary intake surveys, researchers have recently called for separation of these food groups, as well as their subgroups, such as 100% fruit juice vs. whole fruit (3, 4). In keeping with this approach, a recent analysis of the 2003–2010 NHANES revealed that usual daily mean fruit consumption by Americans ≥4 y old is ~1 cup equivalent, one-third of which is 100% fruit juice (5). A majority (79.6%) of Americans ≥2 y old do not meet fruit recommendations (6). Among 19- to 30-y-old women, 92.7% do not meet fruit recommendations (6, 7), and 60% of 1- to 18-y-old children are falling short (8). Although 1 cup of 100% fruit juice is equivalent to 1 cup of whole fruit according to MyPlate communications (2), controversy and confusion abound for this nutrient-packed beverage. This paper reports the proceedings of a satellite session sponsored by the Juice Products Association on 29 April 29 2014 at the Experimental Biology meeting in San Diego, CA, which explored both the controversy surrounding 100% fruit juice and the evidence for its relation to health.
100% Juice beyond Sugar and Calories
Fruit juice comes from whole fruit, a complex group of foods with respect to both sensory and nutritional qualities. According to the US Code of Federal Regulations, “juices directly expressed from a fruit or vegetable (i.e., not concentrated and reconstituted) shall be considered to be 100% juice and shall be declared as ‘100% juice.’” However, when reconstituted from juice concentrate, the US FDA defines 100% juice according to Brix concentrations representative of those originally expressed from the fruit (Figure 1) (9). Many factors affect overall 100% juice quality including physical properties such as Brix concentration (Table 1), acidity, Brix:acid ratio, color, and flavor (10). Maturity and ripeness of the fruit used to make juice drives accumulation of innate sugars, aroma compounds, and, therefore, flavor, as well as changes in acidity, color, and texture (11). Nutritional and functional attributes of juice include typical macronutrients, many micronutrients, and an array of phytonutrients such as flavonoid glycosides found in orange juice and related compounds innate to pomegranate juice (12, 13).
FIGURE 1.
The US regulatory definition of 100% juice vs. other juice-containing beverages. Reproduced from reference 9 with permission.
TABLE 1.
Minimum Brix concentrations required for labeling juice from concentrate as 100% juice1
Fruit | 100% Juice, minimum Brix concentrations |
Apple | 11.5 |
Banana | 22.0 |
Blueberry | 10.0 |
Cranberry | 7.5 |
Grape | 16.0 |
Grapefruit | 10.0 |
Lemon | 4.5 |
Mango | 11.8 |
Orange | 11.8 |
Peach | 10.5 |
Pear | 12.0 |
Pomegranate | 16.0 |
Reproduced from reference 9 with permission.
Nutritional content may vary within fruits, as it does among different forms of a fruit. Nutritional differences in the forms of a food are related at least in part to cultivar variations and in the weights of each of those food forms. Nevertheless, with the exception of fiber and vitamin C, 1 small fruit or 0.5 cup of whole fruit is similar in vitamin and mineral content to 0.5 cup of 100% fruit juice (Table 2) (14). The nutrient profiles of several forms of orange juice are compared relative to energy content (Table 3). This comparison indicates whole fruit and juice are similar except for some nutrients, such as dietary fiber, calcium, and vitamin C.
TABLE 2.
Amounts and %DV of vitamins and minerals per serving of oranges in whole, sliced, and juice forms1
0.5-cup Sections (USDA 09203) | %DV | 0.5 cup, 100% Orange juice2 (USDA 09209) | %DV | 1 Medium whole (USDA 09203) | %DV | 0.5 cup, Canned 100% orange juice (USDA 09207) | %DV | |
Weight of servings, g | 90.5 | 124.5 | 131 | 124.5 | ||||
Energy, kcal | 43 | 61 | 62 | 59 | ||||
Carbohydrate, g | 11.5 | 3.8 | 14.4 | 4.8 | 16.3 | 5.4 | 13.7 | 4.5 |
Total sugars, g | 9.1 | — | 10.4 | — | 12.9 | — | 10.9 | — |
Total dietary fiber, g | 2.4 | 9.6 | 0.4 | 1.6 | 3.4 | 13.6 | 0.4 | 1.6 |
Calcium, mg | 43 | 4.3 | 14 | 1.4 | 61 | 6.1 | 12 | 1.2 |
Magnesium, mg | 10 | 2.5 | 14 | 3.5 | 14 | 3.5 | 12 | 3 |
Potassium, mg | 169 | 4.8 | 222 | 6.3 | 238 | 6.8 | 229 | 6.5 |
Vitamin A, μg RAE | 11 | — | 2 | — | 16 | — | 11 | — |
Vitamin C, mg | 45 | 75 | 41.8 | 70 | 63 | 105 | 37 | 62 |
Folate, μg DFE | 17 | 4 | 24 | 6 | 24 | 6 | 30 | 7.5 |
Reproduced from reference 14 with permission. %DV, percent daily values; DFE, dietary folate equivalent; RAE, retinol activity equivalent.
Includes orange juice from concentrate.
TABLE 3.
Select nutrient content of oranges and juice forms expressed per 43 calories of a serving of oranges in 0.5-cup sections isocalorically1
0.5-cup Orange sections (USDA 09203) | 100% Orange juice2 (USDA 09209) | Canned 100% orange juice (USDA 09207) | |
Calorically equivalent weight, g | 90.5 | 87.8 | 91 |
Energy, kcal | 43 | 43 | 43 |
Carbohydrate, g | 11.5 | 10.2 | 10 |
Total sugars, g | 9.1 | 7.3 | 9 |
Total dietary fiber, g | 2.4 | 0.3 | 0.3 |
Calcium, mg | 43 | 10 | 9 |
Magnesium, mg | 10 | 10 | 9 |
Potassium, mg | 169 | 158 | 167 |
Vitamin A, μg RAE | 11 | 1 | 8 |
Vitamin C, mg | 45 | 29 | 3 |
Folate, μg DFE | 17 | 17 | 22 |
Reproduced from reference 14 with permission. DFE, dietary folate equivalent; RAE, retinol activity equivalent.
Includes orange juice from concentrate.
Phytonutrients, or phytochemicals, are plant metabolites broadly distributed in fruit and fruit juice. As defined by the National Cancer Institute, these components of plants are thought to promote human health but unlike traditional nutrients are not considered essential for life (15). Carotenoids, particularly xanthophylls such as lutein, and carotenes such as β-carotene and lycopene, are commonly found in a wide variety of fruit juices. Polyphenols are also found in many fruit juices, including phenolic acids, stilbenes, ellagic acid, and, particularly, the flavonoids. The flavonoids found most commonly in fruits and fruit juice include anthocyanins, flavan-3-ols, flavonols, flavones, and flavanones (16). Although juice contains these and related polyphenols, their metabolic consequences, biologic properties, and clinical significance remain under study (17).
Maximizing Nutrient Retention in Juice Production
Fresh whole fruits are nutrient-dense, healthful foods that are inherently perishable. Processing fruit, especially when nonthermal technologies are used, into 100% fruit juice can protect nutrient and phytonutrient content. For example, high hydrostatic pressure, sonication technologies have been shown to deactivate degradative enzymes innate to fruit, thereby maintaining product quality and nutritional qualities in watermelon and grapefruit juices while assuring product safety (18–20).
The first critical step in juice production is to select mature, ripe, high-quality fruit that can be processed typically within a day. Ripening is important to full color, flavor development, and nutrient content (11, 21). In contrast, select fruits, e.g., apples, pears, peach, banana, and mango, destined for fresh consumption are often picked mature but allowed to fully ripen in storage or during transit to retail locations. Although optimal quality is achieved often when allowed to ripen on the plant, this early harvest allows the fruit to endure the postharvest handling and transport (11, 22).
Different fruits require different juicing procedures (Figure 2) primarily because of the physical characteristics of the fruit and the desired attributes for the finished product (10). Phytonutrient structure and distribution throughout the fruit vary among different fruits (23). These variables affect the availability of these bioactives in fresh fruits and have implications for optimal juicing procedures to ensure retention in the juice product. For example, 77.3% of the phytonutrients in grapes are found in the seed, 21.6% in the skin, and only 1.1% in the pulp (24). Most of the phenolic and flavonoid compounds in the orange are located in the peel, which includes the flavedo and albedo layers (25–27). Commercial squeezing (juicing) of oranges typically separates 3 fruit into peel and seeds, but through this process, many of the phenolic compounds from these sections are transferred to the juice (28). Compared with home juicing this process allows for some contact between albedo and juice sacks, thus resulting in higher content of phenolics in commercial juice than typically found in home-squeezed products extracted from oranges with minimal extraction of peel and seed components products such as cranberries, apples, and grapes, which are typically crushed, creating a higher amount of contact with phytonutrient-rich skin and seeds that are, in fact, subsequently carried into the juice (29, 30). Despite the presence of many phytonutrients in juice, the bioavailability of the most common polyphenols is quite variable (31).
FIGURE 2.
Juice processing customized for apple, grape, orange, and cranberry (MG Ferruzzi, personal communication, 2014). Adapted from reference 10 with permission.
Heat and pectinase/cellulase enzyme treatments are often applied to aid in extraction, as is common for grapes and cranberries. Enzyme treatments are used with most fruits to extract even more juice from the fiber and juice sacs. The juice is then clarified through filtration and additional enzyme treatments that hydrolyze cellulose and other complex carbohydrates. The juice may be concentrated, usually through evaporation, which facilitates long-term storage and/or blending (32, 33).
Pasteurization, a critical step for reducing microbiologic contamination risk, is used regardless of fruit variety. A thermal treatment of ~90–95°C for 30 s in a hot-fill-hold process can be applied as well as other forms of thermal treatment including canning (sterilization) or aseptic processing (28). This treatment inactivates pathogenic and spoilage microorganisms, as well as degradation enzymes such as pectinases and polyphenol oxidase. Polyphenol oxidase and other innate enzymes must be controlled, either by thermal or nonthermal processing, to ensure the stability of fruit juices and to maintain product quality (34).
Association of Fruit Juice Consumption with Diet Quality and Health
Many reports suggest fruit juice consumption is positively associated with diet quality (35–38). Based on data collected from the 2003–2006 NHANES, the Healthy Eating Index (HEI)9 2005 score (designed to measure compliance with the Dietary Guidelines for Americans) was significantly higher (P < 0.0001) for consumers vs. nonconsumers of 100% juice across age groups (2–5 y, 6–12 y, 13–18 y, and 19+ y) (39). A more recent analysis for NHANES 2007–2010 data found a significant trend (P < 0.0001) toward higher HEI 2010 scores for children who consumed 12 oz of juice/d (HEI = 52.3) than those who did not consume juice (HEI = 43.8) (40)
There are reports that argue fruit juice consumption is comparable with consuming sugar-sweetened beverages that contribute to overweight and obesity, particularly among children (41–43). Important to this argument are quality studies, as noted by the 2010 US Dietary Guidelines for American, which indicate sugar per se does not contribute to weight gain (1, 44).
The total (poly)phenolic content of citrus fruit juices depends on cultivar and stage of ripeness (45). Typically, for citrus fruit, the phenolic content tends to be less in ripe fruit vs. unripe fruit. As a class, flavonoid and phenolics found in fruit juice at concentrations of 51–968 μmol/L have been shown to modulate oxidative stress, inflammatory stress, and microbial growth and activity (46–48). The variability of structure, concentrations, and classic pharmacodynamics of these substances challenges the clinical relevance of some of these compounds at typically consumed concentrations (49, 50). Our understanding of pharmacokinetics, including absorption, distribution, metabolism, and excretion, is critical to ascribe doses and specific health benefits to the spectrum of polyphenols innate to 100% fruit juice typically consumed. Although not the focus of this article, these findings have been thoroughly reviewed elsewhere (51, 52).
Limited epidemiologic evidence suggests an association between certain fruit juices, such as Concord grape, citrus, and cranberry; their polyphenolic compounds; and cardiovascular health (53–55). Possible mechanisms that explain these potential benefits include increased blood flow (56, 57) and blood pressure (58–60), improved endothelial function (56, 57, 61), reduced LDL cholesterol oxidation susceptibility (56), decreased platelet aggregation (62–64), and attenuated inflammation (61, 65).
Fruit Juice and Cognition
The extent to which different polyphenol forms, or their metabolites, may impart specific cognitive benefits is currently a subject of intensive investigation. This includes anthocyanins, flavan-3-ols, and resveratrol, all polyphenol forms common to fruit and juices. Anthocyanin-rich blueberry, strawberry (66–68), blackberry (69), and grape (70) products have demonstrated the ability to attenuate age-related cognitive decline in animal models of aging. Apple, grape, and wine extracts rich in anthocyanins and flavan-3-ols have also demonstrated the ability to minimize cognitive decline in rodent models of Alzheimer’s disease (71).
Our understanding of the metabolic fate of these and other polyphenols often remains speculative with respect to cognitive decline among humans. One of the major hurdles in this arena is the low bioavailability of anthocyanins and related compounds and the rapid plasma clearance of most of the respective metabolites (23). A recent review of 17 epidemiologic studies and several intervention studies suggests there are limited data in this area of interest. Results from intervention studies among those who are >45 y old presenting mild cognitive decline indicate potential improvement in several assessment tools, including word recognition and verbal memory (72). However, these studies indicated considerable variability in fruit juice consumption patterns and cognitive benefits.
Substantial evidence is available to support the effect of cranberry juice on reduced risk of urinary tract infections (UTIs); however, that evidence is insufficient to justify a health claim in Europe or the United States (52, 73). Proanthocyanidin A, a flavan-3-ol particularly high in cranberry, appears to play a key role in UTI protection. Depending on the cause, it appears many women with recurrent UTIs may benefit most (74). Limited evidence suggests that cranberry juice may reduce both UTI incidence and antibiotic use in children (75). A dose of 120 mg of this polyphenol, equivalent to about four 4-oz servings of cranberry juice consumed daily for 3–6 mo supports these types of outcomes based on reduced bacterial adhesion to uroepithelial cells (52).
100% Fruit Juice as an Affordable Component of Dietary Fruit Intakes
Studies of the relation between the nutritional quality and cost of foods have shown that foods with higher nutrient density can cost more per calorie, although not necessarily per nutrient (76–79). The calculations in these studies were based on analyses of energy and nutrient composition of foods and retail price data. For US studies, data were derived from the USDA Food and Nutrient Database for Dietary Surveys and the USDA Center for Nutrition Policy and Promotion. For French studies, data were derived from French national food composition and retail price databases. The US and French studies indicated fruit had the highest energy cost (cost/100 kcal) (38). However, energy density (kcal/100 g) was negatively correlated with energy cost for combined fresh and processed fruits and vegetables. Fresh fruits and vegetables, canned and frozen vegetables, and fruit juices had high nutrient adequacy scores/cost compared with other food categories. In addition, vegetables and fruits were the least-expensive sources of vitamin C, and vegetables and beans were the lowest-cost sources of potassium.
Whole fruit appears to have a greater impact on diet cost than the overall fruit category, including 100% juice, according to an analysis of the relation between diet quality (as measured by HEI 2005) and per calorie diet cost among participants in the 2001–2002 NHANES database (80). Total fruit and whole fruit consumption are important components of the HEI 2005. At higher consumption amounts of total fruit (including both whole fruit and 100% fruit juice) and whole fruit, total diet quality was higher than at lower consumption amounts, but so was per calorie diet cost for both men and women. Overall, the consumption of whole fruit was more strongly associated with a higher diet cost than was the consumption of total fruit.
A dietary modeling study in which all 100% fruit juice was replaced with whole fruit showed a decrease in calories and fiber, as well as an increase in diet cost. In the same study, replacing only the 100% fruit juice that was in excess of the American Academy of Pediatrics (AAP) recommendations with whole fruit resulted in a lower increase in diet cost, while still allowing for a caloric reduction. The lowest-cost model involved replacement of 100% fruit juice with the lowest-cost whole fruit, but potassium was also lowest in this model (81).
Analysis of 2009–2010 NHANES data points to a strong socioeconomic gradient in consumption of whole fruit vs. 100% juice (82). The income:poverty ratio (IPR) is defined by the US Census Bureau as a family’s income divided by the poverty threshold (83). Except for children 4–13 y old, those with the lowest IPR (<1.3) consumed less whole fruit than those with a midrange (1.3–3.5) or high (>3.5) IPR. For children 4–13 y old, the lowest intakes were observed in the 1.3–3.5 IPR group. Within IPR groups, whole fruit consumption across the age groups was distributed in either a u- or j-shaped curve. One hundred percent fruit juice made up ~60% of total fruit consumption but was a lower proportion of the total among those with a higher IPR.
Given the cost barrier to increased whole fruit consumption for those with the least financial resources, modeling was used to assess the roles for whole fruit and 100% juice in helping 4- to 13-y-old children (n = 1071) to meet total fruit intake recommendations of 1–2 servings/d (presented by Adam Drewnowski on 29 April 29 2014 at Experimental Biology, San Diego, CA). Approximately 70% of children aged 4–13 y in the 2009–2010 NHANES cohort were consuming <1.5 servings/d and 85% were consuming <2 servings/d.
One model met the fruit shortfall with whole fruit alone (presented by Adam Drewnowski on April 29, 2014 at Experimental Biology, San Diego, CA). Increasing total fruit consumption to recommended values was associated with significantly higher intakes of dietary fiber, potassium, and vitamin C (P < 0.001). However, total diet cost was also significantly increased above baseline amounts. In the second model, the fruit shortfall was met by a combination of whole fruit and 100% fruit juice. The permitted amounts of 100% fruit juice were capped at the daily intake limit recommended by the AAP (84). The combination of fruit and 100% juice was associated with significantly higher intakes of potassium, calcium, and vitamin C, but not fiber. On the other hand, daily diet costs were not significantly above baseline amounts. Calories were not substantially increased in either model.
Fruit Juice Challenges and Solutions
From a nutrition perspective, fruit is favored by some over 100% fruit juice because of concerns regarding excess consumption and obesity. The 2010 Dietary Guidelines Advisory Committee reviewed longitudinal studies on the relation between 100% fruit juice and adiposity in children and concluded the following: “Limited and inconsistent evidence suggests that for most children, intake of 100 percent fruit juice is not associated with increased adiposity, when consumed in amounts that are appropriate for age and energy needs of the child” (1). This finding is consistent with the conclusion noted by the 2013 Australian Dietary Guidelines committee (85).
The 2010 Dietary Guidelines specifically note that the consumption of 100% fruit juice is not associated with body weight in most children and adolescents (1). However, limited evidence suggests that increased intake of 100% juice has been associated with higher body weight in children and adolescents who were already overweight or obese (1).
The Academy of Nutrition and Dietetics Evidence Analysis Library evaluated the available cross-sectional and longitudinal studies and concluded, “There doesn‘t appear to be a link between weight and fruit juice consumption in children” (86). The strength of evidence was graded as fair (grade II), which indicates studies were of strong design, but the results and conclusions were inconsistent. Both of these exhaustive reviews indicate that more research is needed on this topic (87).
Although some recommendations limit 100% juice to control calories, the continually mounting evidence for reduced risk of chronic diseases with adequate fruit and vegetable consumption (1, 88) is the rationale for recognizing 100% juice as an important option for individuals striving to meet dietary recommendations. The 2010 Dietary Guidelines for Americans recommends 1–2 cup equivalents of fruit per day, with a cup equivalent of fruit defined as 1 cup fresh, 1 cup 100% juice, or 0.5 cup dried fruit (1). The Dietary Approaches to Stop Hypertension diet recommends 4–5 servings of fruit, with 0.5 cup 100% fruit juice noted to be equivalent to 0.5 cup fresh or frozen fruit (89). The AAP guidance for individuals who are 1–6 y old is to limit 100% fruit juice to 4–6 oz/d and for individuals who are 7–18 y old is to limit 100% fruit juice to 8–12 oz/d (83). Finally, the Robert Wood Johnson Foundation acknowledges that 100% juice fits into a healthful diet and advises limits of 4 oz at 2–4 y, 6 oz at 5–10 y, and 8 oz at ≥11 y (90). Around the globe in countries such as Australia, Ireland, and Spain, dietary recommendations similarly include 100% juice as part of a healthful diet (83, 91, 92).
Conclusions
Further research documenting the nutritional value of 100% juice in comparison with whole fruit, both at harvest and throughout a typical period of time from harvest to consumption, would help to improve nutrition communications and inform consumers. Directly examining the impact of 100% juice consumption on health outcomes and physiologic processes such as inflammation will also help to build on existing evidence regarding its role in the human diet and human health, including areas such as cardiovascular health, cognition, and urinary tract health.
It is important to communicate the health benefits of fruit, including 100% juice, more clearly to consumers. Such guidance should incorporate the findings that 100% juice in appropriate amounts can help individuals to meet fruit recommendations without a substantial impact on energy intake or food costs.
Acknowledgments
All authors read and approved the final manuscript.
Footnotes
Abbreviations used: AAP, American Academy of Pediatrics; HEI, Healthy Eating Index; IPR, income:poverty ratio; UTI, urinary tract infection.
References
- 1.USDA and US Department of Health and Human Services. Dietary guidelines for Americans, 2010. 7th ed. Washington (DC): US Government Printing Office; 2010. [DOI] [PMC free article] [PubMed]
- 2.USDA [Internet]. MyPlate. Washington (DC): USDA; 2011 [cited 2014 Jul 1]. Available from: http://www.choosemyplate.gov.
- 3.Roark RA, Niederhauser VP. Fruit and vegetable intake: issues with definition and measurement. Public Health Nutr 2013;16:2–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Moore S, Lloyd B. Improving the comparability of national estimates of fruit and vegetable consumption for cross-national studies of dietary patterns. Food Nutr Bull 2012;33:312–7. [DOI] [PubMed] [Google Scholar]
- 5.Kim SA, Moore LV, Galuska D, Wright AP, Harris D, Grummer-Strawn LM, Merlo CL, Nihiser AJ, Rhodes DG; Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC. Vital signs: fruit and vegetable intake among children—United States, 2003–2010. MMWR Morb Mortal Wkly Rep 2014;63:671–6. [PMC free article] [PubMed]
- 6.Krebs-Smith SM, Guenther PM, Subar AF, Kirkpatrick SI, Dodd KW. Americans do not meet federal dietary recommendations. J Nutr 2010;140:1832–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Moore LL, Singer MR, Mustafa Qureshi M, Loring Bradlee M, Daniels SR. Food group intake and micronutrient adequacy in adolescent girls. Nutrients. 2012;4:1692–708. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.National Cancer Institute. Usual dietary intakes: food intakes, US population, 2007–10. [cited 2015 Jan 23]. Available from: http://appliedresearch.cancer.gov/diet/usualintakes/pop/2007-10/.
- 9.Percentage Juice Declaration for Foods Purporting to be Beverages That Contain Fruit or Vegetable Juice, 21 C.F.R. Sect. 101.30 (2013).
- 10.Bates RP, Morris JR, Crandall JP. Principles and practices of small and medium scale fruit juice processing [Internet]. FAO Agricultural Services Bulletin 146. Rome (Italy): FAO; 2001 [cited 2014 Jun 20]. Available from: http://ucanr.edu/datastoreFiles/234-2085.pdf. [Google Scholar]
- 11.Prasanna V, Prabha TN, Tharanthan RN. Fruit ripening phenomena—an overview. Crit Rev Food Sci Nutr 2007;47:1–19. [DOI] [PubMed] [Google Scholar]
- 12.Bai J, Manthey JA, Ford BL, Luzio G, Cameron RG, Narciso J, Baldwin EA. Effect of extraction, pasteurization and cold storage on flavonoids and other secondary metabolites in fresh orange juice. J Sci Food Agric 2013;93:2771–81. [DOI] [PubMed] [Google Scholar]
- 13.Galindo A, Calín-Sánchez Á, Collado-González J, Ondoño S, Hernández F, Torrecillas A, Carbonell-Barrachina ÁA. Phytochemical and quality attributes of pomegranate fruits for juice consumption as affected by ripening stage and deficit irrigation. J Sci Food Agric 2014;94:2259–65. [DOI] [PubMed] [Google Scholar]
- 14.National Nutrient Database for Standard Reference [Internet]. Release 27. Washington (DC): USDA; 2014 [cited 2014 Dec 14]. Available from: http://www.ars.usda.gov/ba/bhnrc/ndl.
- 15.Drug Dictionary NCI. 2014. [cited 2015 Jan 23]. Available from: http://www.cancer.gov/drugdictionary?cdrid=539361.
- 16.Amarowicz R, Carle R, Dongowski G, Durazzo A, Galensa R, Kammerer D, Maiani G, Piskula MK. Influence of postharvest processing and storage on the content of phenolic acids and flavonoids in foods. Mol Nutr Food Res 2009;53(Suppl 2):S151–83. [DOI] [PubMed] [Google Scholar]
- 17.Manach C, Williamson G, Morand C, Scalbert A, Rémésy C. Bioavailability and bioefficiency in humans. I. Review of 97 bioavailability studies. Am J Clin Nutr 2005;81(Suppl):230S–42S. [DOI] [PubMed] [Google Scholar]
- 18.Liu Y, Zhao XY, Zou L, Hu XS. Effect of high hydrostatic pressure on overall quality parameters of watermelon juice. Food Sci Technol Int 2013;19:197–207. [DOI] [PubMed] [Google Scholar]
- 19.Aadil RM, Zeng X-A, Han Z, Sun D-W. Effects of ultrasound treatments on quality of grapefruit juice. Food Chem 2013;141:3201–6. [DOI] [PubMed] [Google Scholar]
- 20.Zenker M, Heinz V, Knorr D. Application of ultrasound-assisted thermal processing for preservation and quality retention of liquid foods. J Food Prot 2003;66:1642–9. [DOI] [PubMed] [Google Scholar]
- 21.Kader AA. Fruit maturity, ripening, and quality relationships. International Symposium Effect of Pre- & Postharvest factors in Fruit Storage. 1997 Aug 3, Warsaw, Poland. 1999;485;209–14.
- 22.Kader, Adel A. Quality parameters of fresh-cut fruit and vegetable products. In: Fresh-cut fruits and vegetables. Science, technology and market. Boca Raton (FL): CRC Press; 2002. p. 11–20.
- 23.Rodriguez-Mateos A, Vauzour D, Krueger CG, Shanmuganayagam D, Reed J, Calani L, Mena P, Del Rio D, Crozier A. Bioavailability, bioactivity and impact on health of dietary flavonoids and related compounds: an update. Arch Toxicol 2014;88:1803–53. [DOI] [PubMed] [Google Scholar]
- 24.Ivanova V, Stefova M, Chinnici F. Determination of the polyphenol contents in Macedonian grapes and wines by standardized spectrophotometric methods. J Serb Chem Soc. 2010;75:45–59. [Google Scholar]
- 25.Iglesias DJ, Cercós M, Colmenero-Flores JM, Naranjo MA, Ríos G, Carrera E, Ruiz-Rivero O, Lliso I, Morillon R, Tadeo FR, et al. Physiology of citrus fruiting. Braz J Plant Physiol 2007;19:333–62. [Google Scholar]
- 26.Peleg H, Naim M, Rouseff RL, Zehavi U. Distribution of bound and free phenolic acids in oranges (Citrus sinensis) and grapefruits (Citrus paradisi). J Sci Food Agric 1991;57:417–26. [Google Scholar]
- 27.Borges G, Mullen W, Mullan A, Lean MEJ, Roberts SA, Crozier A. Bioavailability of multiple components following acute ingestion of a polyphenol-rich juice drink. Mol Nutr Food Res 2010;54:S268–77. [DOI] [PubMed] [Google Scholar]
- 28.Dauthy ME. Fruit and vegetable processing. FAO Agricultural Services Bulletin No. 119. Rome (Italy): FAO of the United Nations; 1995. [Google Scholar]
- 29.Manach C, Scalbert A, Morand C, Rémésy C, Jiménez L. Polyphenols: food sources and bioavailability. Am J Clin Nutr 2004;79:727–47. [DOI] [PubMed] [Google Scholar]
- 30.Gil-Izquierdo A, Gil MI, Ferreres F. Effect of processing techniques at industrial scale on orange juice antioxidant and beneficial health compounds. J Agric Food Chem 2002;50:5107–14. [DOI] [PubMed] [Google Scholar]
- 31.Del Rio D, Rodriguez-Mateos A, Spencer JPE, Tognolini M, Borges G, Crozier A. Dietary (poly)phenolics in human health: structures, bioavailability, and evidence of protective effects against chronic diseases. Antioxid Redox Signal 2013;18:1818–92. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Bates RP, Morris JR, Crandall PG. Principles and practices of small-and medium-scale fruit juice processing. FAO Agricultural Services Bulletin No. 146. Rome (Italy): FAO of the United Nations; 2001. [Google Scholar]
- 33.Karakaya S. Bioavailability of phenolic compounds. Crit Rev Food Sci Nutr 2004;44:453–64. [DOI] [PubMed] [Google Scholar]
- 34.Spanos GA, Wrolstad RE, Heatherbell DA. Influence of processing and storage on the phenolic composition of apple juice. J Agric Food Chem 1990;38:1572–9. [Google Scholar]
- 35.O’Neil CE, Nicklas TA, Zanovec M, Kleinman RE, Fulgoni VL., III Fruit juice consumption is associated with improved nutrient adequacy in children and adolescents: the National Health and Nutrition Examination Survey (NHANES) 2003–2006. Public Health Nutr 2012;15:1871–8. [DOI] [PubMed] [Google Scholar]
- 36.O’Neil CE, Nicklas TA, Rampersaud GC, Fulgoni VL., III One hundred percent orange juice consumption is associated with better diet quality, improved nutrient adequacy, and no increased risk for overweight/obesity in children. Nutr Res 2011;31:673–82. [DOI] [PubMed] [Google Scholar]
- 37.Murphy MM, Barraj LM, Rampersaud GC. Consumption of grapefruit is associated with higher nutrient intakes and diet quality among adults, and more favorable anthropometrics in women, NHANES 2003–2008. Food Nutr Res 2014;58. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Yang M, Lee SG, Wang Y, Lloyde B, Chung SJ, Song WO, Chun OK. Orange juice, a marker of diet quality, contributes to essential micronutrient and antioxidant intakes in the United States population. J Nutr Educ Behav 2013;45:340–8. [DOI] [PubMed] [Google Scholar]
- 39.O’Neil CE, Nicklas TA, Zanovec M, Fulgoni VL. Diet quality is positively associated with 100% fruit juice consumption in children and adults in the United States: NHANES 2003–2006. Nutr J 2011;10:17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Nicklas T, Rodriguez G, O'Neil C, Fulgoni V., III Association between 100% fruit juice consumption and nutrient intake, diet quality, and weight in children (2–18 yrs.): National Health and Nutrition Examination Survey (NHANES) 2007–2010 (262.8). FASEB J 2014;28:626 (abstr). [Google Scholar]
- 41.Wojcicki JM, Heyman MB. Reducing childhood obesity by eliminating 100% fruit juice. Am J Public Health 2012;102:1630–3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42.Sonneville KR, Long MW, Rifas-Shima SL, Kleinman K, Gillman MW, Taveras EM. Juice and water intake in infancy and later beverage intake and adiposity: Could juice be a gateway drink? Obesity (Silver Spring) 2015;23:170–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Gill JMR, Sattar N. Fruit juice: just another sugar drink? The Lancet Diabetes Endocrinol 2014;2:444–6. [DOI] [PubMed] [Google Scholar]
- 44.Rippe JM, Angelopoulos TJ. Sucrose, high-fructose corn syrup, and fructose, their metabolism and potential health effects: what do we really know? Adv Nutr 2013;4:236–45. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 45.Rekha C, Poornima G, Manasa M, Abhipsa V, Devi JP, Kumar HTV, Kekuda TRP. Ascorbic acid, total phenol content and antioxidant activity of fresh juices of four ripe and unripe citrus fruits. Chem Sci Trans 2012;1:303–10. [Google Scholar]
- 46.Mullen W, Marks SC, Crozier A. Evaluation of phenolic compounds in commercial fruit juices and fruit drinks. J Agric Food Chem 2007;55:3148–57. [DOI] [PubMed] [Google Scholar]
- 47.Yao LH, Jiang YM, Shi J, Tomás-Barberán FA, Datta N, Singanusong R, Chen SS. Flavonoids in food and their health benefits. Plant Foods Hum Nutr 2004;59:113–22. [DOI] [PubMed] [Google Scholar]
- 48.Nile SH, Park SW. Edible berries: bioactive components and their effect on human health. Nutrition 2014;30:134–44. [DOI] [PubMed] [Google Scholar]
- 49.Escudero-López B, Calani L, Fernández-Pachón M-S, Ortega Á, Brighenti F, Crozier A, Del Rio D. Absorption, metabolism, and excretion of fermented orange juice (poly)phenols in rats. Biofactors 2014;40:327–35. [DOI] [PubMed] [Google Scholar]
- 50.Bredsdorff L, Nielsen ILF, Rasmussen SE, Cornett C, Barron D, Bouisset F, Offord E, Williamson G. Absorption, conjugation and excretion of the flavanones, naringenin and hesperetin from α-rhamnosidase-treated orange juice in human subjects. Br J Nutr 2010;103:1602–9. [DOI] [PubMed] [Google Scholar]
- 51.Vinson JA, Liang X, Proch J, Hontz BA, Dancel J, Sandone N. Polyphenol antioxidants in citrus juices: in vitro and in vivo studies relevant to heart disease. Adv Exp Med Biol 2002;505:113–22. [DOI] [PubMed] [Google Scholar]
- 52.Blumberg JB, Camesano TA, Cassidy A, Kris-Etherton P, Howell A, Manach C, Ostertag LM, Sies H, Skulas-Ray A, Vita JA. Cranberries and their bioactive constituents in human health. Adv Nutr 2013;4:618–32. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53.Zamora-Ros R, Jiménez C, Cleries R, Agudo A, Sánchez MJ, Sánchez-Cantalego E, Molina-Montes E, Navarro C, Chirlaque MD, Maria Huerta J, et al. Dietary flavonoid and lignin intake and mortality in a Spanish cohort. Epidemiology 2013;24:726–33. [DOI] [PubMed] [Google Scholar]
- 54.Zamora-Ros R, Knaze V, Luján-Barroso L, Slimani N, Romieu I, Fedirko V, de Magistris MS, Ericson U, Aminoa P, Trichopoulou A, et al. Estimated dietary intake of flavonols, flavanones and flavones in the European Prospective Investigation into Cancer and Nutrition (EPIC) 24-hour dietary recall cohort. Br J Nutr 2011;106:1915–25. [DOI] [PubMed] [Google Scholar]
- 55.Cassidy A, Rimm EB, O’Reilly EJ, Logroscino G, Kay C, Chiuve SE, Rexrode KM. Dietary flavonoids and risk of stroke in women. Stroke 2012;43:946–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 56.Stein JH, Keevil JG, Wiebe DA, Aeschlimann S, Folts JD. Purple grape juice improves endothelial function and reduces the sustainability of LDL cholesterol to oxidation in patients with coronary artery disease. Circulation 1999;100:1050–5. [DOI] [PubMed] [Google Scholar]
- 57.Chou EJ, Keevil JG, Aeschlimann S, Wiebe DA, Folts JD, Stein JH. Effect of ingestion of purple grape juice on endothelial function in patients with coronary heart disease. Am J Cardiol 2001;88:553–5. [DOI] [PubMed] [Google Scholar]
- 58.Park YK, Kim JS, Kang MH. Concord grape juice supplementation reduces blood pressure in Korean hypertensive men: double-blind, placebo controlled intervention trial. Biofactors 2004;22:145–7. [DOI] [PubMed] [Google Scholar]
- 59.Dohadwala MM, Hamburg NM, Holbrook M, Kim BH, Duess MA, Levit A, Titas M, Chung WB, Vincent FB, Caiano TL, et al. Effects of Concord grape juice on ambulatory blood pressure in prehypertension and stage 1 hypertension. Am J Clin Nutr 2010;92:1052–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 60.Morand C, Dubray C, Milenkovic D, Lioger D, Martin JF, Scalbert A, Mazur A. Hesperidin contributes to the vascular protective effects of orange juice: a randomized crossover study in healthy volunteers. Am J Clin Nutr 2011;93:73–80. [DOI] [PubMed] [Google Scholar]
- 61.Buscemi S, Rosafio G, Arcoleo G, Mattina A, Canino B, Montana M, Verga S, Rini G. Effects of red orange juice intake on endothelial function and inflammatory markers in adult subjects with increased cardiovascular risk. Am J Clin Nutr 2012;95:1089–95. [DOI] [PubMed] [Google Scholar]
- 62.Shanmuganayagam D, Warner TF, Krueger CG, ReedJD, Folts JD. Concord grape juice attenuates platelet aggregation, serum cholesterol and development of atheroma in hypercholesterolemic rabbits. Atherosclerosis 2007;190:135–42. [DOI] [PubMed]
- 63.Keevil JG, Osman HE, Jeed JD, Folts JD. Grape juice, but not orange juice or grapefruit juice, inhibits human platelet aggregation. J Nutr 2000;130:53–6. [DOI] [PubMed] [Google Scholar]
- 64.Freedman JE, Parker C III, Li L, Perlman JA, Frei B, Ivanov V, Deak LR, Iafrati MD, Folts JD. Select flavonoids and whole juice from purple grapes inhibit platelet function and enhance nitric oxide release. Circulation 2001;103:2792–8. [DOI] [PubMed] [Google Scholar]
- 65.Dalgård C, Nielsen F, Morrow JD, Enghusen-Poulsen H, Jonugn T, Hørder M, de Maat MP. Supplementation with orange and blackcurrant juice, but not vitamin E, improves inflammatory markers in patients with peripheral arterial disease. Br J Nutr 2009;101:263–9. [DOI] [PubMed] [Google Scholar]
- 66.Joseph JA, Shukitt-Hale B, Denisova NA, Bielinski D, Martin A, McEwen JJ, Bickford PC. Reversals of age-related declines in neuronal signal transduction, cognitive, and motor behavioral deficits with blueberry, spinach, or strawberry dietary supplementation. J Neurosci 1999;19:8114–21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 67.Barros D, Amaral OB, Izquierdo I, Geracitano L, do Carmo Bassols Raseira M, Henriques AT, Ramirez MR. Behavioral and genoprotective effects of Vaccinium berries intake in mice. Pharmacol Biochem Behav 2006;84:229–34. [DOI] [PubMed] [Google Scholar]
- 68.Ramirez MR, Izquierdo I, do Carmo Bassols Raseira M, Zuanazzi JA, Barros D, Henriques AT. Effect of lyophilised Vaccinium berries on memory, anxiety and locomotion in adult rats. Pharmacol Res 2005;52:457–62. [DOI] [PubMed] [Google Scholar]
- 69.Shukitt-Hale B, Cheng V, Joseph JA. Effects of blackberries on motor and cognitive function in aged rats. Nutr Neurosci 2009;12:135–40. [DOI] [PubMed] [Google Scholar]
- 70.Shukitt-Hale B, Carey A, Simon L, Mark DA, Joseph JA. Effects of Concord grape juice on cognitive and motor deficits in aging. Nutrition 2006;22:295–302. [DOI] [PubMed] [Google Scholar]
- 71.Shih PH, Chan YC, Liao JW, Wang MF, Yen GC. Antioxidant and cognitive promotion effects of anthocyanin-rich mulberry (Morus atropurpurea L.) on senescence-accelerated mice and prevention of Alzheimer's disease. J Nutr Biochem 2010;21:598–605. [DOI] [PubMed] [Google Scholar]
- 72.Lamport DJ, Saunders C, Butler LT, Spencer JPE. Fruits, vegetables, 100% juices, and cognitive function. Nutr Rev 2014;72:774–89. [DOI] [PubMed] [Google Scholar]
- 73.Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infection. Cochrane Database Syst Rev 201210:CD001321. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 74.Takahashi S, Hamasuna R, Yasuda M, Arakawa S, Tanaka K, Ishikawa K, Kiyota H, Hayami H, Yamamoto S, Kubo T, et al. A randomized clinical trial to evaluate the preventive effect of cranberry juice (UR65) for patients with recurrent urinary tract infection. J Infect Chemother 2013;19:112–7. [DOI] [PubMed] [Google Scholar]
- 75.Salo J, Uhari M, Helminen M, Korppi M, Nieminen T, Pokka T, Kontiokari T. Cranberry juice for the prevention of recurrences of urinary tract infection in children: a randomized placebo-controlled trial. Clin Infect Dis 2012;54:340–6. [DOI] [PubMed] [Google Scholar]
- 76.Drewnowski A. The cost of US foods as related to their nutritive value. Am J Clin Nutr 2010;92:1181–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 77.Darmon N, Darmon M, Maillot M, Drewnowski A. A nutrient density standard for vegetables and fruits: nutrients per calorie and nutrients per unit cost. J Am Diet Assoc 2005;105:1881–7. [DOI] [PubMed] [Google Scholar]
- 78.Drewnowski A. The Nutrient Rich Foods Index helps to identify healthy, affordable foods. Am J Clin Nutr 2010;91:1095S–101S. [DOI] [PubMed] [Google Scholar]
- 79.Drewnowski A. New metrics of affordable nutrition: which vegetables provide most nutrients for least cost? J Acad Nutr Diet 2013;113:1182–7. [DOI] [PubMed] [Google Scholar]
- 80.Rehm CD, Monsivais P, Drewnowski A. The quality and monetary value of diets consumed by adults in the United States. Am J Clin Nutr 2011;94:1333–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 81.Monsivais P, Rehm CD. Potential nutritional and economic effects of replacing juice with fruit in the diets of children in the United States. Arch Pediatr Adolesc Med 2012;166:459–64. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 82.Drewnowski A, Rehm CD. Socioeconomic gradient in consumption of whole fruit and 100% fruit juice among US children and adults. Nutr J 2015;14:3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 83.US Census Bureau [Internet]. How the Census Bureau Measures Poverty [cited 2014 Dec 16]. Available from: http://www.census.gov/hhes/www/poverty/about/overview/measure.html.
- 84.Committee on Nutrition. American Academy of Pediatrics: the use and misuse of fruit juice in pediatrics. Pediatrics 2001;107:1210–3. [DOI] [PubMed] [Google Scholar]
- 85.Australian Dietary Guidelines 2013 [Internet]. Carlton (Australia): Nutrition Australia. [cited 2015 Jan 23]. Available from: www.nutritionaustralia.org.
- 86.Academy of Nutrition and Dietetics Evidence Analysis Library [Internet]. Dietary and Metabolic Impact of Fruit Juice Consumption Evidence Analysis Project. Chicago: Academy of Nutrition and Dietetics; 2014 [cited 2014 Jul 1]. Available from: http://andevidencelibrary.com/topic.com?cat=5113.
- 87.Academy of Nutrition and Dietetics. Evidence Analysis Library. Chicago: Academy of Nutrition and Dietetics. [cited 2015 Jan 23]. Available from: https://www.andeal.org/topic.cfm?menu=5113.
- 88.Oyebode O, Gordon-Dseagu V, Walker A, Mindell JS. Fruit and vegetable consumption and all-cause, cancer and CVD mortality: analysis of Heath Survey for England data. J Epidemiol Community Health 2014;68:856–62. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 89.Lin PH, Aickin M, Chammpagne C, Craddick S, Sacks FM, McCarron P, Most-Windhauser MM, Rukenbrod F, Haworth L; DASH-Sodium Collaborative Research Group. Food group sources of nutrients in the dietary patterns of the DASH-Sodium trial. J Am Diet Assoc 2003;103:488–96. [DOI] [PubMed] [Google Scholar]
- 90.Robert Wood Johnson Foundation [Internet]. Recommendations for Healthier Beverages. Princeton (NJ): Robert Wood Johnson Foundation; 2013 [cited 2014 Jul 1]. Available from: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf404852.
- 91.The Department of Health, Republic of Ireland. Your Guide to Healthy Eating [Internet]. Dublin (Ireland): The Department of Health; 2012 [cited 2014 Jul 1]. Available from: http://www.dohc.ie/publications/pdf/YourGuide_HealthyEating_FoodPyramid.pdf?direct=1.
- 92.NAOS Pyramid [Internet]. Spanish Agency for Food Safety and Nutrition. Madrid: Government of Spain [cited 2014 Jul 1]. Available from: http://www.naos.aesan.msssi.gob.es/en/csym/piramide/.