The Women, Infants, and Children food package and 100% fruit juice

Authors: KLEINMAN, RONALD - Harvard Medical School; NICKLAS, THERESA - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of the American Medical Association
Publication Type: Other
Publication Acceptance Date: 12/18/2016
Publication Date: 2/1/2017
Citation: Kleinman, R.E., Nicklas, T.A. 2017. The Women, Infants, and Children food package and 100% fruit juice. Journal of the American Medical Association. 171(2):197-198. doi:10.1001/jamapediatrics.2016.4116.

Interpretive Summary:

Technical Abstract: For those of us who are professionally concerned with infant and childhood nutrition, the nutritional support of our most vulnerable infants, children, and their families is a very high priority. Therefore, it is most important to continue to examine and improve the Women, Infants, and Children (WIC) Food Package. In that regard, Nagata et al have suggested that there is strong evidence to support their viewpoint that 100% fruit juice is significantly associated with dental caries and overweight in children and should be replaced by whole fruits in the WIC food package. However, extensive evidence within the last 2 years not presented in their statement does not support their recommendation and, in contrast, suggests that 100% fruit juice can in fact be a healthy component of a child's diet and the WIC Food Package. For example, Vargas et al analyzed data on preschool children from several nationally representative health examination surveys and found no association between intake of 100% fruit juice and early childhood caries. With regard to overweight and obesity, a published review of the scientific evidence did not show an association between 100% fruit juice consumption and weight status in children and in fact determined that drinking 100% fruit juice may be a marker for a healthful diet, as evidenced by a higher intake of important nutrients and overall diet quality (a higher Healthy Eating Index score) in drinkers of 100% fruit juice compared with non-drinkers. In addition, children also ate more whole fruit than non–juice drinkers, suggesting that 100% juice complements rather than competes with whole-fruit intake. This review further supported the conclusion of another systematic review published in 2015 that also found that the consumption of 100% fruit juice was not associated with weight status or adiposity in children. The 2015-2020 Dietary Guidelines for Americans also recognize 100% juice as a nutrient-dense beverage, a member of the fruit "group," and, along with water and milk, one of the "primary beverages consumed." The Dietary Guidelines for Americans report notes that young children aged 1 to 8 years are the only group to meet their fruit intake goals with a combination of both fruit juice and whole fruit. Thus, the weight of published current evidence suggests that these Dietary Guidelines for Americans recommendations remain valid and that 100% fruit juice should continue to be an option for all children including WIC participants and others with a limited budget.