Whole Fruits Versus 100% Fruit Juice: Revisiting the Evidence and Its Implications for US Healthy Dietary Recommendations

ABSTRACT

Scientific literature remains inconsistent on whether and to what extent 100% fruit juice should be recommended in the diet. Specifically, the current Dietary Guidelines for Americans (DGA) do not specifically refer to free sugars in fruit juice, and further clarification to provide more explicit guidance may be needed in the 2025–2030 version. We compared evidence on whole fruit and 100% fruit juice regarding its nutrient composition, impact on hunger and satiety, and association with chronic health conditions while highlighting the potential public health perspectives and implications for healthy dietary recommendations. Processing and/or storing 100% fruit juice reduces its fibre, vitamins and other antioxidant contents and transforms intrinsic sugars in the whole fruit into free sugars. Fruit consumed in solid form provides greater satiety due to delayed gastric emptying and related physiological reactions. The synergistic effects of polyphenols and fibre in whole fruit benefit the gut microbiome by acting as prebiotics and producing short‐chain fatty acids that reduce inflammation. Although the evidence surrounding 100% fruit juice on chronic conditions remains inconsistent, accumulating studies indicate a more consistently beneficial role of whole fruits. The research evidence reviewed highlights the need for the DGA to update the recommendations on fruit juice, including emphasising the health benefits of whole fruit over fruit juice, providing a clear guideline on the daily fruit juice allowance, defining “free sugars” in fruit juice, and clarifying the distinction between 100% fruit juice and fruit drinks.

1. Introduction

The obesity epidemic has reached concerning levels in the United States (US), with rates tripling since the late 1970s (Kranjac and Kranjac 2023). This rise in obesity has significant health consequences, including increased risks of chronic conditions such as hypertension, type 2 diabetes, metabolic syndrome and cancer (Clark et al. 2023). Sugar‐sweetened beverages (SSBs) contain substantial levels of added sugars that have been associated with weight gain and contribute to rising obesity levels (Malik and Hu 2022). The World Health Organization (WHO)'s definition of free sugars includes not only added sugar in SSBs but also “free sugars” naturally present in products like 100% fruit juices (WHO 2015). These juices are often perceived as a healthy option, which raises concerns about their potential impact on health if there is no clear definition of, or instruction on, free sugars in dietary guidelines (Sah et al. 2021; WHO 2015). Dietary guidelines in the US and the underlying scientific literature are inconsistent on whether and to what extent 100% fruit juice should be recommended in the diet. Those in favour of including fruit juice in the diet suggest that fruit juice is an easy way to help meet the daily fruit recommendations and that it is more than just a source of free sugars, containing useful nutrients alongside (O'neil et al. 2012; Sakaki et al. 2019). On the flip side, critics emphasise the high sugar content in the form of free sugars in fruit juice and the lack of dietary fibre, which makes it very similar to other SSBs (Guasch‐Ferré and Hu 2019). Inconsistent recommendations from authoritative bodies, such as the 2020–2025 Dietary Guidelines for Americans (DGA), the American Academy of Paediatrics (AAP), the UK's Eatwell Guide and the Nordic Nutrition Recommendations, further contribute to the debate (Heyman et al. 2017, USDA 2020, Public Health England 2016, Blomhoff et al. 2023). The 2020–2025 DGA recommends that at least half of the daily recommended fruit intake of two cups a day should come from whole fruits, implicitly allowing the other half to be fulfilled by 100% fruit juice. Moreover, the DGA did not explicitly define the sugars in fruit juices as “free sugars”, despite specifying that added sugars should contribute less than 10% of total daily calories (USDA 2020). According to the WHO's definition, “free sugars” include “all monosaccharides and disaccharides added to foods and beverages by manufacturers, cooks, or consumers, as well as sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates” (WHO 2015). This is distinct from “intrinsic sugars,” which are naturally incorporated within the structure of whole fruits and vegetables (WHO 2015). The lack of a clear definition of “free sugars” in fruit juices within the DGA leaves room for ambiguity and may require further clarification to align with international standards.

In contrast, the AAP provides clear recommendations on limits of fruit juice intake in young children's diets: a maximum of 4 oz per day for 1–3 year‐olds, 4–6 oz per day for 4–6 year‐olds, and 8 oz per day for 7–18 year‐olds (8 oz = 236.6 mL). The AAP also recommends eliminating fruit juice for children experiencing abnormal weight gain (Heyman et al. 2017). These limits, however, are significantly higher than those recommended in Europe. For example, the UK's Eatwell Guide advises adults to consume a variety of at least five portions of fruits and vegetables per day while limiting 100% fruit juice to 150 mL (equivalent to one portion per day) and explicitly highlights the presence of free sugars in fruit juice (Public Health England 2016). The recent Nordic Nutrition Recommendations also recommend that intake of fruit juice is limited for children (Blomhoff et al. 2023).

In light of the ongoing disagreements and inconsistent recommendations, this review aims to compare the evidence looking at whole fruits and 100% fruit juice in terms of their nutrient composition, impact on hunger and satiety, and associations with chronic health conditions. The goal is to provide an overview of the scientific evidence to inform and support the updating of healthy dietary recommendations.

2. Methods

We searched CINAHL, PubMed and Scopus for peer‐reviewed articles published in English. Our search strategy included a combination of relevant keywords, including ‘fruit juice’, ‘fruit’, and ‘whole fruit’. Studies were included if the exposure included 100% fruit juice and/or whole fruits. We included observational studies (e.g., case–control studies, cohort studies), experimental studies (e.g., randomised control trials), systematic reviews and/or meta‐analyses, as well as narrative reviews. We excluded studies that only focused on fruit drinks or sugar‐sweetened beverages, vegetable or vegetable juice and those published in languages other than English. The final review includes 12 observational studies, 26 intervention studies, 2 systematic reviews, 6 meta‐analyses, 27 systematic reviews with meta‐analyses and 10 narrative review articles (see Data S1).

2.1. Comparison of Nutrient Contents Between 100% Fruit Juice and Whole Fruits

The nutrient composition of 100% fruit juice differs significantly from that of whole fruits, particularly in free sugar and fibre content. Whole fruits contain significantly more dietary fibre compared to 100% fruit juice (US Department of Agriculture 2016). Conversely, 100% fruit juice is high in free sugars. Whole fruits contain high levels of dietary fibre and redox compounds, with intrinsic sugars that are bound within the fruit's cell structure. For example, one whole navel orange (140 g) contains about 12 g of intrinsic sugar. Three to four oranges can yield approximately 1 cup (240 mL or 8 fluid ounces) of 100% orange juice, during which the intrinsic sugars are converted to free sugars (Walker et al. 2014; US Department of Agriculture 2016). In addition, research indicates that oranges, apples and grapefruits have greater antioxidant density when consumed as whole fruits than in juice or pulp form (Crowe and Murray 2013; Czech et al. 2021). This suggests the health advantages of whole fruits extend beyond their antioxidant potential (Crowe and Murray 2013, Czech et al. 2021). Furthermore, converting whole fruits into juice requires significant processing and pasteurisation. These processes, along with the prolonged storage periods, negatively impact the nutrient content in fruit juice and contribute to the loss of unstable compounds such as ascorbic acid (vitamin C). For example, two studies on strawberries have shown that heat processing whole raw strawberries into puree, juice, nectar and wine significantly reduced the antioxidant compounds such as 17%–22% of vitamin C, 21%–67% of anthocyanins and 27%–30% of phenols (Klopotek et al. 2005; Hartmann et al. 2008). They also reported that not just the processing but also the storage of strawberry juice and puree led to a reduction in the antioxidant capacity (Hartmann et al. 2008). With regard to commercially available orange juice, Salar and colleagues observed a reduction in vitamin C levels but found that the remaining amount was nutritionally significant (Salar et al. 2024). Some research studies also suggested the significant bioavailability of polyphenols in orange juice (Aschoff et al. 2016, 2015; Brett et al. 2009). In addition to thermal processing, high‐pressure processing can also impact the polyphenol content and lead to the degradation of its health‐enhancing effects, as indicated by studies on blueberries (Howard et al. 2012). Membrane‐based processing techniques that do not involve heat have been proposed as alternatives to preserve the beneficial nutrient compounds in fruit juices, but nutrient loss is still apparent (Chandra et al. 2021).

2.2. Impact of Fruit Form on Hunger, Satiety and Related Metabolic Responses

Whether fruit is consumed in solid form (i.e., whole fruit) or liquid form (i.e., juice) may have an impact on hunger and satiety regulation, which have a crucial role in weight management and related health outcomes. Research has shown that fruit, when consumed in solid form, leads to higher satiation (i.e., a feeling of fullness), compared to fruit consumed in the form of purees and juices (Mattes and Campbell 2009; Rogers and Shahrokni 2018). This may be due to dietary fibre, which is present in whole fruit, delaying gastric emptying and prolonging the feeling of fullness (Rogers and Shahrokni 2018). A study by Flood‐Obbagy and Rolls used preloads of apples in the form of whole apples, applesauce and apple juice (with and without added fibre) and demonstrated that consuming whole apples led to reduced lunch energy intake and greater satiety compared to applesauce and apple juice (Flood‐Obbagy and Rolls 2009). Similarly, Houchins and colleagues conducted a small, randomised crossover study and found that overweight and obese participants felt less satiated and hungrier shortly after consuming fruit in beverage form compared to the solid form. However, this difference diminished over time (Houchins et al. 2013). Another study conducted by Rogers and Shahrokni used the preload test meal method and found that eating fruits in the form of a fruit salad (i.e., solid form), led to greater satiety, slower consumption and a perception of being more food‐like compared to a fruit smoothie (Rogers and Shahrokni 2018). A meta‐analysis on food texture and satiety found that food in solid form significantly reduced hunger compared to foods in liquid and low viscous forms (Stribiţcaia et al. 2020). Whole fruit requires chewing which impacts appetite. A systematic review and meta‐analysis with 13 trials found that mastication of food reduces self‐reported hunger and promotes satiety (Miquel‐Kergoat et al. 2015). The same study also found that increasing the number of chews per bite enhances the release of satiety‐related gut hormones. Additionally, a dietary fibre prebiotic component called pectin, found in apples and other fruits such as prunes, dates, kiwi, banana and plantains, has been shown to decrease colonic transit time, alleviate constipation symptoms, increase the production of short‐chain fatty acids, boost the number of beneficial gut bacteria like Bifidobacteria and reduce the number of pathogenic bacteria (Emery et al. 1997; Alvarez‐Acosta et al. 2009; Mitsou et al. 2011; Lee et al. 2012; Xu et al. 2014; Eid et al. 2015). While fruit juices do contain some fibre, the levels are lower than those found in whole fruits. Moreover, the fibre and polyphenols in whole apples may have synergistic effects mediated by the gut microbiome, leading to potential beneficial effects on metabolic status, including cardiovascular health (Bondonno et al. 2017). Importantly, whole fruits generally elicit more favourable metabolic responses for insulin sensitivity and glucose regulation compared to fruit juices (Bolton et al. 1981; Halvorsen et al. 2021; Liao et al. 2023). A study by Haber and coworkers provided an apple‐based test meal to 10 healthy participants and found that apple juice without fibre was consumed 11 times faster than whole apples. This indicates that removing fibre from apples can increase the speed of ingestion, reduce feelings of fullness and impair glucose regulation, as serum insulin levels rose to a greater extent after consuming apple juice than whole apples (Haber et al. 1977).

2.3. Differential Associations Between Whole Fruit, 100% Fruit Juice and Risks of Chronic Diseases

2.3.1. Type 2 Diabetes and Metabolic Biomarkers

Quite a few randomised controlled trials (RCTs) have examined the association between 100% fruit juice and metabolic biomarkers, and the results are inconsistent. Two meta‐analyses of RCTs, published in 2014 and 2017, found that 100% fruit juice consumption, compared to sugary beverages or placebos, did not significantly impact fasting glucose and insulin concentrations, although the results on the marker for insulin resistance were inconsistent (Wang et al. 2014; Murphy et al. 2017). Since the comparison group included sugar‐sweetened beverages, sweetened fruit juice, sugar‐free beverages and water, flavoured water or low flavonoid drink, it may indicate that 100% fruit juice might not be significantly different from those drinks on fasting glucose and insulin concentration. Still, the beneficial aspects of fruit juice compared to those drinks cannot be neglected.

Orange juice has been regarded as a healthy option because of the high bioavailability of nutrients such as vitamin C and other polyphenols (Aschoff et al. 2015, 2016; Brett et al. 2009). However, two meta‐analyses of RCTs on orange juice and glucose parameters had inconsistent results. The one published in 2021 did not find significant associations of orange juice with blood glucose parameters as well as other metabolic biomarkers except reduced total cholesterol and improved insulin resistance (Motallaei et al. 2021). Another meta‐analysis study published in 2022 found that orange juice was associated with reduced glucose levels, insulin and the marker for insulin resistance, and the result was even robust in subgroups with orange juice consumption ≥ 500 mL/day (Alhabeeb et al. 2022). It is noteworthy that all those studies compared orange juice with other beverages instead of whole oranges (Motallaei et al. 2021; Alhabeeb et al. 2022).

In a meta‐analysis using lower consumption of 100% fruit juice as the comparison group, they found that increased consumption of 100% fruit juice by 1 serving/day led to a 7% increased risk of type 2 diabetes when adjusted for obesity (Imamura et al. 2015). Another meta‐analysis study found that a higher intake of sugar‐sweetened fruit juice was associated with increased risks of type 2 diabetes, but this association was not significant for 100% fruit juice (Xi et al. 2014; D'elia et al. 2021). The result of this study highlights that sugar‐sweetened fruit juice is not a healthier choice, and it is important to understand the difference between 100% fruit juice and other fruit drinks with added sugar.

The association between whole fruit and diabetes was analysed in a meta‐analysis of cohort studies published in 2021 (Halvorsen et al. 2021). They found that a higher intake of fruits, compared to a lower intake, was associated with reduced risks of type 2 diabetes. In the same study, within the subtype of fruit, whole fruits (e.g., apples, pears, blueberries, grapefruit, grapes and raisins) demonstrated a continued inverse relationship. However, fruit drinks and fruit juice were associated with increased risks of diabetes, but no statistically significant association was found for 100% fruit juice.

With regards to gestational diabetes mellitus (GDM), a meta‐analysis of cohort studies showed that high fruit consumption, compared to low consumption, was associated with a decreased risk of GDM whereas no association was found with high fruit juice consumption (Liao et al. 2023). Additionally, a dose–response analysis conducted in the same study found that the risk of GDM lowered by 3% for a 100 g/day increase in whole fruit consumption.

2.3.2. Cardiovascular Health and Related Mortality

During the past decade, numerous research studies have examined the association between 100% fruit juice and the risk of cardiovascular diseases (CVD), including hypertension, coronary heart disease (CHD) and stroke. Three meta‐analyses of RCTs found that 100% fruit juice was associated with decreased systolic blood pressure (SBP) and diastolic blood pressure (DBP) but the associations with total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein (HDL‐C) cholesterol levels or triglyceride (TG) levels were mixed (Liu et al. 2013; Wang, Gallegos, et al. 2021; D'elia et al. 2021). Interestingly, D'Elia et al.'s study detected a significant inverse association between low‐moderate 100% fruit juice consumption and the risk of stroke (up to 200 mL/day) or total cardiovascular events (up to 170 mL/day). In these three meta‐analyses, 100% fruit juice was compared to no consumption, water or other placebo beverages.

In a meta‐analysis of prospective cohort studies, Liu and coworkers reported that 100% fruit juice showed a protective association with incident hypertension only at moderate doses (100 mL/day). At the same time, increased risks could be detected when the intake was greater than 200 mL/day. However, only two prospective cohort studies were included in this dose–response analysis (Liska et al. 2019). A meta‐analysis found that 100% fruit juice, compared to low intake or no intake, was not associated with CVD incidence (5 cohorts) and CVD mortality (1 cohort) but the incidence of stroke (4 cohorts) was significantly reduced by 18% and the total mortality reduced by 33% (Zurbau et al. 2020). Another meta‐analysis revealed no association of fruit juice with total and cause‐specific mortality (Wang, Li, et al. 2021). Additionally, a recent meta‐analysis of prospective cohort studies was unable to draw conclusions on the association between fruit juice and CVD‐related mortality due to the limited number of available studies (Bhandari et al. 2024).

Studies on orange juice were slightly different. In the three meta‐analyses, orange juice was compared to various controls, including placebo drinks, no consumption, energy‐matched comparators and aerobic exercise. Notably, in studies involving exercise, the comparison was between fruit juice combined with aerobic exercise versus aerobic exercise alone. Orange juice significantly reduced total cholesterol levels in these comparisons but had no significant effect on LDL‐C, HDL‐C or TG levels (Motallaei et al. 2021). However, these results were not consistent with a recent systematic review and meta‐analysis, which found that orange juice consumption, compared to no consumption, reduced‐calorie diet or a placebo drink, had no significant beneficial effect on serum TG, HDL‐C or total cholesterol but only reduced LDL‐C (Alhabeeb et al. 2022). Mixed results were found for inflammatory biomarkers, including interleukin‐6 (IL‐6), CRP (hs‐CRP) or malondialdehyde (MDA) (Cara et al. 2022).

The association between whole fruits and CVD seems to be fairly consistent. A meta‐analysis of RCTs examining the combined effects of whole fruit and vegetable intake found that consuming > 3 servings (240 g) compared to < 3 servings of whole fruits and vegetables were associated with a significant reduction in diastolic blood pressure and TG with marginal reductions in total cholesterol and LDL‐C (Toh et al. 2020). In several meta‐analyses of cohort studies, decreased risks of hypertension, CHD or CVD were observed when high whole fruit intake was compared to low or no intake (Gan et al. 2015; Liu et al. 2019; Zurbau et al. 2020; Madsen et al. 2023). One exception was reported in Madsen et al.'s study, where they found a subgroup of whole fruit (e.g., cantaloupe [100 g/day]), was associated with an increased risk of hypertension. This result was similar to the findings of the Halvorsen et al. 2021 study, where they found two subgroups of whole fruit, watermelon and cantaloupe (100 g/day each), were associated with an increased risk of diabetes.

The inverse association between whole fruit and metabolic syndrome is consistent among different studies, including dose–response analyses (Tian et al. 2018; Lee, Lim et al. 2019; Semnani‐Azad et al. 2020). On the other hand, 100% fruit juice was not associated with a reduced risk of metabolic syndrome (Semnani‐Azad et al. 2020). A U‐shaped dose–response relationship between 100% fruit juice consumption and metabolic syndrome was observed, indicating that 125 mL/day of 100% fruit juice may protect against metabolic syndrome. However, no such protective association was found beyond 200 mL/day (Semnani‐Azad et al. 2020).

2.3.3. Weight and Obesity

The association between 100% fruit juice and weight gain or obesity has been explored across various populations. Meta‐analyses of RCTs did not find an association between 100% fruit juice and weight gain or obesity when compared to placebo drink or no intervention (Motallaei et al. 2021; D'elia et al. 2021; Alhabeeb et al. 2022). However, a positive association between 100% fruit juice consumption and weight gain has been demonstrated in several meta‐analyses of cohort studies (Crowe‐White et al. 2016; Auerbach et al. 2017; Nguyen et al. 2024), although the association was attenuated when energy intake was adjusted. In addition, this relationship is more pronounced in younger children compared to older children and adults (Auerbach et al. 2017, Nguyen et al. 2024).

Research on whole fruit consumption and its relationship with weight gain and obesity consistently shows a negative association, and further systematic reviews of RCTs and cohort studies confirm these findings (Hebden et al. 2017; Guyenet 2019).

2.3.4. Other Chronic Conditions

Several meta‐analyses of cohort studies found that high consumption of 100% fruit juice compared to low consumption is associated with increased risks of thyroid cancer, melanoma, squamous cell carcinoma, breast cancer, and cancer overall (Li et al. 2021; Farvid et al. 2021; Pan et al. 2023). On the other side, whole fruit intakes were associated with a reduced risk of ovarian cancer and breast cancer (Hurtado‐Barroso et al. 2020; Farvid et al. 2021).

The positive association of 100% fruit juice (per serving/week) and the protective effect of whole fruits (an additional one serving/day) was further observed in chronic conditions such as gout, ulcerative colitis, and Crohn's disease (Ayoub‐Charette et al. 2019; Milajerdi et al. 2021).

Many studies have also explored the impacts of fruit juice on oral health, and the results were notable. They found that immersion of teeth in fruit juice leads to increased microleakage, tooth erosion and a reduction in the salivary pH, thereby contributing to dental caries and other oral health conditions (Saha et al. 2011; Katge et al. 2016; Nazir et al. 2020). A systematic review by Lisak and coauthors did not find a significant association between 100% fruit juice and tooth erosion and dental caries among children and adolescents, but the results, primarily from clinical trials with higher (> 750 mL) than normal (< 250 mL) intakes, showed that 100% fruit juice might contribute to these outcomes among adults (Liska et al. 2019).

Collectively, many studies have shown an increased risk of chronic diseases with high 100% fruit juice consumption, while a few studies found non‐significant results (See Table 1). It is noteworthy that most of these studies compared 100% fruit juice to other beverages or lower intake levels. High‐quality RCTs comparing 100% fruit juice with whole fruit are scarce. Moreover, many of these studies have emerged since the last DGA update. They provide new evidence for challenging the current stance of the DGA on 100% fruit juice intake.

TABLE 1.

Systematic reviews and/or meta‐analyses of 100% fruit juice consumption or whole fruits with chronic diseases.

Exposure	Chronic condition	Type of research study	Comparator	Risks of chronic conditions	References
100% Fruit juice	Type II diabetes	Meta‐analysis of cohort studies	High consumption compared to no consumption	Increased	Imamura et al. 2015
	Hypertension	Meta‐analysis of prospective cohort studies	> 200 mL/day compared to no consumption	Increased	Liu et al. 2019
	Weight gain	Meta‐analysis of cohort studies	Highest consumption versus lowest consumption	Increased	Crowe‐White et al. 2016
	Weight gain	Meta‐analyses of cohort studies	One serving per day compared to no consumption	Increased	Auerbach et al. 2017; Nguyen et al. 2024
	Thyroid cancer, Melanoma, Squamous cell carcinoma, Overall cancer	Meta‐analysis of cohort studies	High consumption (> 250 mL/day) compared to low consumption	Increased	Pan et al. 2023
	Breast cancer	Dose–response meta‐analysis of observational studies; Meta‐analysis of prospective studies	High consumption compared to low consumption	Increased	Li et al. 2021; Farvid et al. 2021
	Gout	Meta‐analysis of cohort studies	Highest intake versus lowest intake	Increased	Ayoub‐Charette et al. 2019
	Tooth erosion	Systematic review of cohort studies	> 250 mL over 10 min 4×/day	Increased	Liska et al. 2019
	Hypertension	Meta‐analysis of prospective cohort studies	100 mL/day compared to no consumption	Decreased	Liu et al. 2019
	Stroke incidence	Meta‐analysis of cohort studies	High consumption compared to low consumption	Decreased	Zurbau et al. 2020
	Metabolic syndrome	Meta‐analysis of cohort studies	125 mL/day compared to no consumption	Decreased	Semnani‐Azad et al. 2020
	Diabetes	Meta‐analysis of cohort studies	Highest intake versus lowest intake	Not significant	Xi et al. 2014
Whole fruits	Type II diabetes	Meta‐analysis of cohort studies	High consumption compared to low consumption	Decreased	Halvorsen et al. 2021
	Gestational diabetes mellitus	Dose–response meta‐analysis of cohort studies	100 g/day increase in whole fruit consumption	Decreased	Liao et al. 2023
	Coronary heart disease	Meta‐analysis of prospective cohort studies	High consumption compared to low consumption	Decreased	Gan et al. 2015
	Hypertension	Meta‐analysis of cohort studies	High consumption compared to low consumption	Decreased	Liu et al. 2019; Madsen et al. 2023
	Cardiovascular Disease	Meta‐analysis of cohort studies	High consumption compared to low consumption	Decreased	Zurbau et al. 2020
	Stroke	Meta‐analysis of cohort studies	High consumption compared to low consumption	Decreased	Zurbau et al. 2020
	Metabolic syndrome	Meta‐analysis of cohort studies	100 g/day increase in consumption; high consumption compared to low consumption	Decreased	Lee, Lim et al. 2019; Tian et al. 2018; Semnani‐Azad et al. 2020
	Weight gain/obesity	Systematic review of RCT and cohort studies	Various comparators	Decreased (mediated by total energy intake)	Hebden et al. 2017; Guyenet 2019
	Ovarian cancer	Meta‐analysis of cohort studies	High consumption compared to low consumption	Decreased	Hurtado‐Barroso et al. 2020
	Breast Cancer	Meta‐analysis of observational studies	High consumption compared to low consumption	Decreased	Farvid et al. 2021
	Inflammatory bowel disease	Meta‐analysis of cohort studies	High consumption compared to low consumption	Decreased	Milajerdi et al. 2021

2.4. Public Health Perspectives on 100% Fruit Juice and Whole Fruit

Although meta‐analyses of cohort studies have found that 100% fruit juice is associated with increased risks of certain chronic diseases, the public health value of 100% fruit juice cannot be ignored. First, 100% fruit juice could be a cheaper option for populations residing in food deserts due to its easier transportation and storage (Monsivais and Rehm 2012). Fresh whole fruits, on the other hand, are more expensive and not as readily available as 100% fruit juice in the local convenience stores or corner markets. Second, compared to fresh whole fruits, 100% fruit juice has a much longer shelf life and can be stored for longer periods. Third, 100% fruit juice may offer a more convenient option for busy individuals or those with limited time if the preparation process of whole fruits (e.g., cleaning, peeling and cutting) is considered. Overall, 100% fruit juice may serve as a more affordable and convenient source of nutrients to meet the diverse needs of different populations. However, it is easy to misclassify fruit drinks with added sugars as fruit juice. Therefore, individuals may order fruit drinks that are more like SSBs and do not have the same benefits as 100% fruit juice. Research studies found that children and US households with low income, low educational attainment, and those from racial or ethnic minority groups are more likely to purchase fruit drinks, consume them more frequently or exceed the AAP recommended daily intake of fruit juice for children (Beck et al. 2013; Drewnowski and Rehm 2015; Vercammen et al. 2018; Lee, Kubik et al. 2019; Duffy et al. 2023). Hence, providing nutrition education through nutrition label reading becomes crucial for promoting awareness about the difference between 100% fruit juice and other fruit drinks. Moreover, researchers have suggested changing policies to promote whole fruit consumption and limit the consumption of fruit juices and fruit drinks (Wojcicki and Heyman 2013; Nagata et al. 2016; Pomeranz and Harris 2020; Muth et al. 2019). The relative public health value of 100% fruit juice compared to either whole fruit and/or fruit drinks with added sugar is complex, suggesting that the 2025–2030 DGA recommendations on 100% fruit juice will need to be nuanced. A more stringent guideline with a more apparent distinction between whole fruits, 100% fruit juices, and fruit drinks with added sugar should be discussed; the WHO definition of free sugars needs to be incorporated, and the appropriate limits of fruit juice may need to be specified as in dietary guidelines in the UK, the Nordic countries and elsewhere (WHO 2015, Public Health England 2016, Blomhoff et al. 2023).

3. Conclusion

Compared to whole fruits, 100% fruit juice offers greater accessibility, convenience and longer shelf‐life. However, it is high in free sugars, low in dietary fibre and some studies have found higher intake levels of 100% fruit juice compared to lower intake levels associated with increased risks of various chronic conditions including diabetes, weight gain and more. As such, we must be cautious when considering 100% fruit juice as a means to meet up to half of the recommended daily intake of fruits, particularly among children and low‐income minority communities who are already at risk of exceeding the AAP recommended daily fruit juice limits for children. The research evidence reviewed highlights the need for the 2025–2030 DGA to update the recommendations on fruit juice. It is essential to emphasise the benefits of whole fruit over fruit juice, provide a clear visual guideline on the daily 100% fruit juice allowance, define the term “free sugars” in fruit juice, and clarify the distinction between 100% fruit juice and fruit drinks for adults and children.

Author Contributions

Hemangi B. Mavadiya contributed to the conceptualisation, literature review, draft of the first version of the review and editing. Dahyun Roh contributed to literature review, review writing and editing. Andrew Ly contributed to literature review, review writing and editing. Yunxia Lu contributed conceptualisation and initiation, supervision, review writing and critical editing.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1.

Data Availability Statement

This is a review, and we cited information from previous publications.