Fruit juice: just another sugary drink?

The evidence for a role of sugar-sweetened beverages (SSBs) in the development of obesity and associated comorbid ities, although not fully resolved, is becoming increasingly convincing, with supporting data from both prospective cohort studies and randomised trials. The obesogenic eff ect of SSBs seems to be simply a consequence of the excess calories provided by their consumption, rather than of any specifi c adverse eff ects of fructose-containing sugars that they contain, with no clear evidence that excess energy intake from SSBs is any more harmful than is excess energy intake from any other source. However, liquids have a smaller satiating eff ect than do solid foods, and consequently excess calories consumed in liquid form are not fully compensated for by reduction of intake of other foods. Although more evidence is needed to fully elucidate the probable eff ect size on obesity of reduction of SSB intake at a population level, evidence exists that non-alcoholic beverages contribute a substantial proportion of daily sugar intake (about a quarter of sugar intake in the UK), are consumed separately from other dietary components, are of little nutritional benefi t, and that alternatives in the form of low-sugar drinks and water are readily available. Thus, to target their reduction represents low-hanging fruit in terms of public health nutritional policy, and debate is ongoing regarding the potential advantages and disadvantages of an increase in taxation on SSBs as a mechanism to reduce intake. By contrast with the growing consensus to limit SSB intake, consumption of fruit is regarded as virtuous, with WHO guidelines recommending consumption of fruit and vegetables—eg, in the UK, the guidelines recommend fi ve servings per day, and one of these portions can be in the form of fruit juice. However, fruit juice has a similar energy density and sugar content to SSBs: 250 ml of apple juice typically contains 110 kcal and 26 g of sugar; 250ml of cola typically contains 105 kcal and 26·5 g of sugar. Additionally, by contrast with the evidence for solid fruit intake, for which high consumption is generally associated with reduced or neutral risk of diabetes, high fruit juice intake is associated with increased risk of diabetes. Of course, SSBs and pure fruit juices are not identical— unlike (unfortifi ed) SSBs, fruit juices contain vitamins and minerals, so could conceivably be of value for individuals consuming micronutrient-poor diets. However, this micronutrient content might not be suffi cient to off set the adverse metabolic consequences of excessive fruit juice consumption—eg, consumption of 480 ml of high-antioxidant concord grape juice per day for 3 months increased insulin resistance and waist circumference in overweight adults in one randomised controlled trial. Thus, contrary to the general perception of the public, and of many health-care professionals, that drinking fruit juice is a positive health behaviour, their consumption might not be substantially diff erent in health terms from consumption of SSBs. To reduce sugary drink intake requires dietary behaviour change. Although taxation and other government policies—eg, restriction of vending machines—might play a part in mediation of dietary behaviour changes, nutritional knowledge and awareness are also key. We hypothesised that public perception of the healthiness of fruit juices might be based on poor awareness of their sugar content. To test this, we surveyed a nationally representative group of 2005 adults, living across the UK, using validated online polling methods, to assess knowledge of sugar content of a range of SSBs, fruit juices, and smoothies. We showed participants pictures of full containers of diff erent non-alcoholic beverages and asked them to estimate the number of teaspoons of sugar contained in the portion shown. Although the sugar content of all