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The Option of Replacing the Special Supplemental Nutrition Program for Women, Infants, and Children Fruit Juice Supplements With Fresh Fruits and Vegetables

Jason M. Nagata, MD, MSc1; Jennifer T. Djafari, MD2; Lisa J. Chamberlain, MD, MPH1
[+] Author Affiliations
1Department of Pediatrics, Stanford University, Palo Alto, California
2Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California
JAMA Pediatr. 2016;170(9):823-824. doi:10.1001/jamapediatrics.2016.1178.
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This Viewpoint proposes the option of replacing the Special Supplemental Nutrition Program for Women, Infants, and Children fruit juice supplements with fresh fruits and vegetables.

Vouchers from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) that currently must be used toward fruit juice should allow for the option to be used for fresh fruits or vegetables given the potential detrimental health effects on children of consuming 100% fruit juice on a regular basis. Although the juice is derived from fruit, its consumption is associated with obesity1 and dental caries.2 From 2003 to 2009, the consumption of 100% fruit juice per day increased among minorities such as Latino and African American children, while it decreased among white children.3 A cohort of 8950 children demonstrated that drinking 100% fruit juice regularly at 2 years of age was associated with an increased odds (adjusted odds ratio, 1.30 [95% CI, 1.06-1.60]) of becoming overweight by 4 years of age compared with infrequently drinking or not drinking 100% fruit juice.4

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Re: The option of replacing the WIC fruit juice supplements with fresh fruits and vegetables
Posted on August 8, 2016
Taylor C. Wallace, Robert Murray, Elizabeth Pivonka
Department of Nutrition and Food Studies, George Mason University; Department of Human Sciences, The Ohio State University; Produce for Better Health Foundation
Conflict of Interest: Authors have received research support from Welch's within the past three years.
The viewpoint by Nagata and others (1) that WIC vouchers for 100% fruit juice should allow the purchase of fresh fruits or vegetables is an opinion based on several assumptions contradicted by scientific literature.

The statement that 100% fruit juice has increased among some subpopulations of children is misleading as this data from the cross-sectional telephone California Health Interview Survey is not supported by findings from the validated US CDC’s National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of Americans. NHANES data indicate that younger children consume ~40% of their fruit servings as 100% fruit juice (2). Intake of 100% fruit juice among children is well below American Academy of Pediatrics’ (AAP) recommendations. Evidence shows that 100% fruit juice consumption is associated with improved nutrient intakes, including key shortfall nutrients such as potassium and vitamin C, and better diet quality, especially among lower income populations (2). Data also indicate that reducing or eliminating 100% fruit juice could widen fruit intake gaps and promote consumption of less nutritious choices such as sugar-sweetened beverages, especially among low-income and minority populations (3).

A handful of cross-sectional studies suggest that 100% fruit juice may contribute to weight gain and dental caries, but a much larger body of evidence contradicts these conclusions. In a recent review, we found 22 studies suggesting 100% fruit juice does not contribute to weight gain, of which 13 indicated that consumption may contribute to increased satiety (3). The AAP, National Academies of Medicine (NAM), and 2015-2020 Dietary Guidelines for Americans support this opinion. Emerging data from two clinical trials suggest that the polyphenols present in 100% juice may attenuate a significant portion (~40%) of glucose and insulin response in both healthy and diabetic individuals after consuming 100% fruit juice (4,5).

In the same review, we found four studies suggesting that 100% fruit juice does not contribute to dental caries (3). The NAM committee reviewing WIC Packages similarly found no association between childhood dental caries and 100% fruit juice consumption.

The position of Nagata et al. also assumes that WIC participants have access to fresh fruits and that fresh is nutritionally superior to other forms of fruit. 100% fruit juice is less expensive, widely available, and has a longer shelf life.

Even well intentioned ideas like those of Nagata et al. can have ramifications beyond their immediate intent. This idea is one of them.


1. Nagata JM, Djafari JT, Chamberlain LJ. The option of replacing the Special Supplemental Nutrition Program for Women, Infants, and Children fruit juice supplements with fresh fruits and vegetables [published online July 11, 2016]. JAMA Pediatrics. doi: 10.1001/jamapediatrics.2016.1178.

2. O’Neil CE, Nicklas TA, Zanovec M, et al. 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;15:1871-1878.

3. Byrd-Bredbenner C, Ferruzi MG, Fulgoni VL, et al. Satisfying America’s fruit gap: summary of an expert roundtable on the role of 100% fruit juice. Adv Nutr. 2016;(submitted; under review).

4. Johnston KL, Clifford MN, Morgan LM. Possible role for apple juice phenolic compounds in the acute modification of glucose tolerance and gastrointestinal hormone secretion in humans. J Sci Food Agric. 2002;82:1800-1805.

5. Banihani SA, Makahleh SM, El-Akawi Z, et al. Pomegranate juice ameliorates insulin resistance, enhances B-cell function, and decreases fasting serum glucose in type 2 diabetic patients. Nutr Res. 2014;34(1):862-867.
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