Examining the differences in frequency of consuming whole fruits versus 100% fruit juice on cardiovascular disease indicators in u.s. adults: analysis of 2019 behavioral risk factor surveillance system

Authors: KESLER, BRENDAN - University Of North Dakota; Hess, Julie; BODENSTEINER, ANNE - University Of North Dakota; PALMER, DANIEL - University Of North Dakota; TANDE, DESIREE - University Of North Dakota

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/14/2026
Publication Date: N/A
Citation: N/A

Interpretive Summary: Both whole fruit and 100% fruit juice are considered servings of the "fruit" group, according to the 2020-2025 Dietary Guidelines for Americans. However, compositional differences between these two products and their nutrient profiles (notably, the amount of fiber and phytochemicals differ between whole fruit and juice) indicate that whole fruit and fruit juice may have different impacts on health outcomes. The purpose of this study was to evaluate associations between eating whole fruit compared to drinking fruit juice on cardiovascular health outcomes including blood pressure, blood cholesterol, and heart attack. The findings indicate that some adults who consume fruit juice frequently were more likely to have high cholesterol and have experienced a heart attack than frequent whole fruit consumers, even after adjusting for age, education, income, and smoking status. However, because of the limitations of the dataset used for this investigation, additional research is clarify the relationships between fruit form and cardiovascular disease risk.

Technical Abstract: Objectives: The Dietary Guidelines for Americans includes both whole fruit and 100% fruit juice (“juice”) in the fruit category; however, there are compositional differences between whole fruit and juice that could impact health. We hypothesized that whole fruit consumption frequency would be lower- but frequency of drinking juice would be higher- in adults with less favorable cardiovascular disease (CVD) risk factors or disease markers. Methods: Data from the 2019 Behavior Risk Factor Surveillance System (BRFSS) was used to assess U.S. adults (n= 371,038) self-reported intakes of whole fruit and juice. Additional data on cardiovascular risk factors or disease markers was identified from BRFSS participants related to high blood pressure, high blood cholesterol, angina/coronary heart disease (CHD), heart attack, or stroke. Independent sample t-tests were performed on each cardiovascular disease risk factor. Linear regression was also performed to determine whether mean whole fruit consumption and juice consumption frequency significantly differed between groups with and without CVD or CVD risk factors. Results: Mean consumption frequency of juice in the entire study population was 0.30 times per day, and mean consumption frequency of whole fruit was 1.06 times per day. Approximately 34% of the study population had been diagnosed with high blood pressure, 32% with high cholesterol, 4% had experienced a heart attack or been told they had CHD, and 3% had suffered a stroke. Two-sample t-tests indicate that whole fruit consumption frequency was lower in adults who self-reported high blood pressure (p<0.0001), high cholesterol (p<0.0001), heart attack (p<0.0001), CHD (p=0.0020), or stroke (p<0.0001) and that juice consumption frequency was higher in adults who self-reported high blood pressure (p<0.0001), heart attack (p<0.0001), CHD (p=0.0166), or a stroke (p<0.0001). High blood pressure, blood cholesterol, heart attack, and CHD remained significant predictors of whole fruit consumption when accounting for age, education, income, and smoking in linear regression models. Only high cholesterol and heart attack incidence were significant predictors of juice intake in regression models. Conclusions: Additional research should examine the relationship between fruit form and cardiovascular health to pinpoint potential mechanisms as well as identify strategies to increase whole fruit consumption in the U.S. population.