American Academy of Pediatrics Revises Kids Juice Recommendations

A new policy statement released Monday by the American Academy of Pediatricians (AAP) recommends some children should be consuming less 100 percent juice products than previously advised.

The new policy, titled “Fruit Juice in Infants, Children and Adolescents: Current Recommendations,” recommends that 100 percent fruit juice should not be provided to children younger than 1 year of age, with the exception of cases in which there is a strong clinical basis for use in the management of constipation. The previous version of the policy, written in 2001 and reaffirmed several times subsequently, had suggested infants could begin consuming juice at around six months of age.

For children aged 1-3 years, the new AAP statement recommends a maximum daily intake of 4 ounces of 100 percent fruit juice products. For children ages four to six years old, the new policy suggests a limit of 4 to 6 ounces per day; for children between the ages of seven and 18, juice intake should be limited to 8 ounces, down from 12 ounces, or 1 cup of the recommended 2 to 2.5 cups of daily fruit servings.

While noting that fruit juice has historically been recommended by pediatricians as a source of vitamin C, the AAP statement cited high sugar content, along with a lack of protein and fiber, as potential detrimental effects of excessive juice consumption in children. Adding to concerns, data from 2008 to 2013 revealed that children two to 18 years of age consume nearly half of their fruit intake as juice.

“Fruit juice offers no nutritional benefits over whole fruit for infants and children and has no essential role in healthy, balanced diets for children,” read the second of nine conclusions included at the end of the policy statement.

As such, the statement recommends that “children should be encouraged to eat whole fruit to meet their recommended daily fruit intake and should be educated regarding the benefit of fiber intake and the longer time to consume the same kilocalories when consuming whole fruit compared with fruit juice.”

In an interview with BevNET, Dr. Steven Abrams, M.D., Director of the Dell Pediatric Research Institute at the University of Texas at Austin and co-author of the AAP policy statement, said that the updated recommendation is intended to clarify the difference in nutritional value between juice and fruit.

“We recognized that science supports the concept that a small amount of fruit juice can be part of a healthy diet and that small amounts of fruit juice do not lead to obesity,” he said. “On the other hand, we don’t want people to assume that [whole] fruit and fruit juice are entirely equal in their health benefits.”

The statement does note that excessive juice consumption may contribute to obesity in children and adolescents ages seven to 18, though it cites contrasting results from several studies that sought to define a link between the two. It states that more research is required before conclusions can be made.

Dr. Abrams noted that further research was also needed to determine if juices that undergo high-pressure processing (HPP), a non-thermal pasteurization method which inactivates harmful bacteria and helps retain nutrients, would address some of the AAP’s areas of concern.

“We need more data on the nutritional profiles of different types of juices and different outcomes from different forms of juices,” he said. “I think we do have a place for future research and investigations that will ask the question do some forms of processing pack even more fiber and more vitamins and is there a difference between forms of fruit juice.”

According to the Dietary Guidelines For Americans 2015-2020, the recommended daily serving of fruits for a healthy eating pattern for adults is two cups per day. One cup of 100 percent fruit juice is equivalent to one cup of fruit. However, the Guidelines state that at least half of the recommended amount of fruits should come from whole fruits.

BevNET reached out to several juice companies working in this space for their reaction to the new policy statement and how their products are positioned as a healthy choice for kids.

Earlier this year, tart cherry juice maker Cheribundi debuted a kid-focused product line made with water and 50 percent juice called Cheribuddy. Available in four flavors, the drink contains 60 calories and 13g of sugar per 6.75 oz. serving.

In an e-mail to BevNET, CEO Steve Pear said “Tart cherry juice has been shown to aid consumers who suffer from sleep deprivation” and noted that 10 million kids suffer from such issues.

Suja Juice co-founder and CEO Jeff Church stated in an e-mail: “It has never been Suja’s strategy to target children, so we do not anticipate that these new recommendations will impact the business in any way.”

The Juice Products Association, a trade group representing the fruit and juice products industry, issued a statement on Monday in response to the AAP’s new recommendations saying “we agree with the AAP’s policy statement published today… that reaffirms that 100 percent fruit juice, in both fresh and reconstituted forms, ‘can be a healthy part of the diet of children older than 1 year when consumed as part of a well-balanced diet.’”

The statement also noted that “additional research shows that the average child does not over consume juice and that children who drink juice have better overall diet quality.”

When asked what to describe what the nutritional profile of an ideal healthy juice product for kids might look like, Dr. Abrams said he was hesitant to frame the conversation in those terms.

“We really want to focus on the idea of fruit juices as a small part of the beverage containment for kids, but we still want focus on fresh fruits, so I would be cautious about trying to say that adding this or adding that [vitamin or mineral] is where we need to go,” he said.