Fruit Juice
Linked to
Childhood
Obesity?
Evaluation of juice
intake and BMI in
Ontario preschoolers
June 4, 2010
Northern Health Research Conference
Sudbury, Ontario
Pamela Brunelle, NODIP
Lee Rysdale, NRC
Janis Randall Simpson, U of G
Christopher Knee, U of G
Heather Keller, U of G
Presentation Outline
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Background
Objectives
Methodology
Results
Future Research
Practice Points
Questions
Background
• >26% of Canadian children aged 2-17 are
overweight or obese.
• Do specific eating habits play an etiological role?
• Fruit juice - common beverage of young children
– easy to drink
– tastes good
– parents believe it is a healthy choice
• High/increased intake of sugar-sweetened drinks
(pop, fruit drinks, etc.) are considered a serious
obesity risk.
• Role of 100% fruit juice in promoting excess
weight for height is less understood.
Background
American Academy of Pediatrics
– Limit children’s intake of 100% fruit juice to
4-6 oz/ day (125-175 mL/day).
– Evaluate fruit juice intake when assessing
childhood overweight and obesity.
Eating Well with Canada’s Food Guide
– Limit fruit-flavoured, soft and sweetened
drinks.
– One serving of vegetable/fruit juice is 125 mL.
– No specific recommendations for the number
of juice servings per day.
Background
Adiposity Rebound
• Preschool years-critical period for obesity
prevention.
• Children’s Body Mass Index (BMI) is normally
lowest around age 4 to 6.
• “Adiposity rebound” occurs after this age.
• If “adiposity rebound” occurs before age 5.5
years, increased risk for obesity later in life.
Source: http://www.biomedcentral.com/1471-2431/4/6/figure/F1
Background
• No current information on fruit juice
intakes of Canadian children.
• No data to suggest associations with BMI
in Canadian preschoolers.
• Previous studies on the effects of fruit
juice on children’s BMI
– inconsistent methodologies
– contradictory findings
– Canadian comparisons difficult
Study Objectives
1. Describe 100% fruit juice intake
amongst a sample of Ontario
preschoolers.
2. Investigate associations between fruit
juice and BMI and select child, parental
and family characteristics.
3. Provide fruit juice consumption data on
a Canadian population for comparative
studies and nutrition surveillance.
Methodology
• Secondary data analysis from NutriSTEP®
validation study (May 2005 to January 2006).
• Sample: 254 preschool children (aged 3-5),
living in Ontario communities:
– Greater Sudbury and Manitoulin Island
– York Region
– London area
• Fruit juice data from three-day food intake
records.
• Children’s weight and height for BMI
measured by RD.
• Demographic characteristics: an 8-item
standardized questionnaire from Stats CAN.
NutriSTEP®
Nutrition Screening Tool for Every Preschooler
• Fast and simple way to assess eating habits and
identify nutrition problems early.
• Parent-completed 17-item questionnaire on
preschool nutrition risk constructs:
– food/nutrient intake
– physical growth
– developmental and physical capabilities
– physical activity and inactivity
– food security and the feeding environment
• Research data extracted from the validation study.
www.nutristep.ca
Methodology
• Juice intake cut-points:
– <125ml/day , 125-250ml/day, and >250
mL/day
• BMI categories:
– ≤85th percentile, >85th percentile
• Bivariate analyses:
– Juice intake
– BMI category
– Child, parental and family characteristics
Results
• 23.6% of preschoolers were overweight
or at risk of being overweight.
• 88% of children consumed at least some
fruit juice.
• Mean fruit juice intake was 210 mL/day.
• Over half (57%) consumed more than
125 mL/day.
• One third (31%) consumed more than
250 mL/ day.
Results
Figure 1- Preschooler proportions in categories of fruit juice intake and BMI
Results
• No significant differences were
seen in fruit juice intake
amongst BMI categories.
• Preschoolers living in homes with
3 or 4 children appeared to consume
more fruit juice.
• The same sample of preschoolers had
low consumption of grains (54.3%), fruits
(54.6%), vegetables (44.6%), milk and
alternatives (24.5%), and meat and
alternatives (31.6%).
Future Research
• A larger and more diverse sample is
needed.
• Investigate other associations between
juice consumption and key nutrients.
• Determine role of overall beverage
consumption in total energy intake and
weight status in the preschool years.
• Measure parental nutrition knowledge
and attitudes and determine the ability of
these characteristics to predict children’s
eating habits.
Practice Points
• Fruit juice intake may influence quality
and consumption of other beverages.
• Support and educate parents:
– CFG including child-size servings
– Offer juice and milk during or at the end of
meals
– Water in between meals
Conclusions
• Results support many previous studies.
• 100% fruit juice consumption does not
appear to be associated with children’s
BMI.
• Longitudinal diet research
with more ethnically and sociallyeconomically diverse parents of
preschoolers is recommended.
Rysdale LA, Brunelle PL, Randall Simpson JA, Knee CA, Keller HH. Evaluation of
fruit juice intake and Body Mass Index within a sample of Ontario preschoolers.
Infant, Child, & Adolescent Nutrition (2009); 1 (3): 170-175
Acknowledgements
• Co-authors, University of Guelph
– Dr. Janis Randall Simpson
– Christopher Knee
– Dr. Heather Keller
• Manuscript Reviewers
– Joanne Beyers, Sudbury & District Health Unit
– Mary Turfryer, York Region Health Department
• NutriSTEP® name and logo are owned by
the Sudbury & District Health Unit.
Questions?