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Current perspectives and challenges in the estimation of fruit juice consumption across the lifecycle in Europe

Published online by Cambridge University Press:  15 February 2024

Janette Walton Open the ORCID record for Janette Walton [Opens in a new window]  and
Laura Kehoe Open the ORCID record for Laura Kehoe [Opens in a new window]
Janette Walton*
Affiliation:
Department of Biological Sciences, Munster Technological University, Cork, Republic of Ireland
Laura Kehoe
Affiliation:
Department of Biological Sciences, Munster Technological University, Cork, Republic of Ireland
*
*Corresponding author: Janette Walton, email: janette.walton@mtu.ie
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Abstract

Fruit juice (FJ) is typically low in energy, contains natural sugars, important amounts of micronutrients and is not permitted to have added sugars/sweeteners. However, its role in a healthy diet is under scrutiny partly due to the wider adoption of the definition for free sugars in nutrition policy. This review aimed to identify data on FJ consumption from national food consumption surveys across Europe, to examine current intakes, percent consumers and its contribution to intakes of energy, total sugars, free sugars, vitamin C, folate and potassium. Data were extracted on the population mean intake of FJ and its contribution to nutrient intakes across the lifecycle and crude estimates of population mean intakes across countries were reported for the total population and for consumers only. This review highlighted significant gaps/challenges regarding the availability of country-specific national food consumption surveys across Europe and specifically data on FJ consumption (including complexities surrounding categorisations). Nonetheless, using a comparable/homogenous definition, the mean intake of FJ among consumers was approximately 1 × 150 ml glass/day for adults/older adults, with lower intakes among infants (86 g/d), children (108 g/d) and teenagers (112 g/d). FJ made important contributions to intakes of vitamin C while making little contribution to energy intakes but also contributed 2–14 % of free sugars intake (which may be considered modest compared to other sources). The complexity of collating and interpreting data on FJ intake as elucidated in this review raises questions surrounding the categorisation of FJ in research and presents significant challenges for policymakers with respect to dietary guidance for FJ.

Keywords

Fruit juiceDietary roleVitamin CFree sugarsBeveragesNational food consumption surveys
Type
Review Article
Information
Nutrition Research Reviews , First View , pp. 1 - 12
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Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Nutrition Society

Introduction

Fruit juice is defined in European law as the fermentable but unfermented product obtained from fruit, which is sound and ripe, fresh or preserved by chilling, of one or more kinds mixed together, having the characteristic colour, flavour and taste typical of the juice of the fruit from which it comes(1). Flavour, pulp and cells from the juice which are separated during processing may be restored to the same juice, but sugars or sweeteners may not be added nor can extra water be added, beyond the concentration (Brix) of the original juice(1). In contrast to 100 % fruit juice (FJ), nectars and fruit drinks are permitted to contain added sugars and/or sweeteners as well as other ingredients, such as botanicals(1).

Current guidance on FJ consumption from food-based dietary guidelines (FBDG) is mixed, with some countries including it as part of the recommended intakes of fruit & vegetables (either as unlimited quantities or with guidance to limit to one portion or varying quantities (100–200 ml)). However, other countries include FJ as part of the recommended intakes of beverages within their FBDG (related to its contribution to total fluid intake) and others explicitly recommend avoiding it (grouping it with other sweet beverages)(Reference Herforth, Arimond and Álvarez-Sánchez2–4).

While few studies have collated data on the intake of FJ or its contribution to dietary intakes across countries, one recent global review of beverage intakes in over 187 countries found that adults consumed an average of 0·16 x 8oz servings (∼36 g) of FJ daily(Reference Singh, Micha and Khatibzadeh5), however, to the best of the authors’ knowledge there are no such studies for children or teenagers. A large study of national food consumption surveys in the United States (US), United Kingdom (UK) and Brazil estimating FJ intakes in consumers only (across all age groups) reported intakes in these countries of 184 g/d, 130 g/d and 249 g/d, respectively(Reference Mitchell, Musa-Veloso and Fallah6). With regard to the role of FJ in the overall diet, studies have shown that FJ consumption is associated with overall better diet quality and increased intakes of nutrients such as vitamin C, folate and potassium in children, teenagers and adults(Reference Byrd-Bredbenner, Ferruzzi and Fulgoni III7–Reference Murphy, Barraj and Brisbois12) however, some have also reported that FJ intake is associated with higher intakes of energy and total sugars(Reference Bellisle, Hébel and Fourniret11,Reference Murphy, Barraj and Brisbois12) . Despite potential associations of FJ with energy and sugars intake, studies have shown that FJ consumption is not consistently associated with an increased risk for overweight/obesity or excess body weight among children, teenagers or adults with many concluding that, in the context of a healthy dietary pattern, consumption of FJ may provide beneficial nutrients and contribute to overall intakes of fruit and vegetables without having a negative impact on body weight(Reference Mitchell, Musa-Veloso and Fallah6,Reference O’Neil, Nicklas and Rampersaud13–Reference Moore, Zhou and Wan16) .

Despite the aformentioned evidence, the role of FJ in a healthy diet is under scrutiny due to its sugar and dietary fibre content per serving compared to the whole fruit counterpart, with the debate increasing in recent years alongside the wider adoption of the definition for free sugars in nutrition policy (replacing the previous definition of added sugars) since free sugars also include the natural sugars present in FJ, honey and syrups(17–Reference Allergens and Turck19). Within Europe, in the context of setting tolerable upper intake levels for sugar, the European Food Safety Authority (EFSA) have reported that FJ contributes 15–50 % of free sugar intakes for consumers only. However this is likely to represent an overestimate since EFSAs categorisation included nectars and FJ with added ingredients in addition to fruit juices and vegetable juices and should be interpreted with caution in the setting of guidance at population level(Reference Allergens and Turck19). In contrast, the UK Scientific Advisory Committee on Nutrition (SACN) provided a more conservative population-wide estimate in the UK of 8–14 % for the contribution of FJ to non-milk extrinsic sugars (NMES) intake (used for the setting of guidance on free sugars)(17). These differences highlight the significant challenges in the interpretation of data used for policy making with respect to FJ consumption and dietary guidance.

In order to provide a reliable evidence-base for setting FBDG or nutrition policy with regards to specific foods, such as FJ, there is a need for the following: (1) precise and consistent characterisation (to examine a reasonably homogenous food category) and (2) data on current consumption patterns within a population group(20). Therefore, the aim of this review was to identify available data on FJ consumption from national food consumption surveys across Europe and to examine current intakes and the proportion of consumers of FJ and to determine its contribution to intakes of energy, total sugars, free sugars, vitamin C, folate and potassium across the lifecycle.

Methods

Data were identified and extracted between December 2022 and August 2023. For this review, Europe was defined using a list of the 53 countries within the WHO European Union (EU) region. To identify the countries within this list which have conducted national food consumption surveys, the authors used relevant reviews(Reference Huybrechts, Aglago and Mullee21–Reference van Rossum, ter Borg and Nawijn24) and searches of the grey and published literature for national food consumption surveys. Where necessary, the reports/studies were translated into English, to the best of the authors’ ability using a web-based free-to-user translation service (Google Translate). Surveys were included in this review if they were nationally representative of their respective country (as stated in the study reports), collected dietary data at an individual level and had published summary data which was publicly available (i.e. no raw data were analysed). For surveys where food consumption data were available, the availability of FJ consumption data was identified by the overall food group reported (e.g. ‘fruit & vegetables’, ‘beverages’) and the most disaggregated reporting category (e.g. FJ, pure juices). To ensure only comparable data on FJ were included in this review, the survey reports were analysed to the best of the authors’ ability to determine what was included in the FJ category. While this was not always clear, some surveys included components such as nectars, olives and vegetable juices in the FJ category and were excluded from this review on FJ (with the exception of 100 % vegetable juice, which would be considered similar to FJ with regards to nutritional composition). Therefore, only data which met the comparable/homogenous definition of 100 % pure fruit and vegetable juice were extracted further for this review.

Data for this review were extracted by population subgroups (i.e. infants; 0–3 years, children; 4–10 years, teenagers; 11–17 years, adults; 18–64 years and older adults; 65+ years) and categorised using the closest fit of age-groups reported from each survey. Where data were published by sex only or by smaller subgroups for age, the data were weighted using the provided n values to give one value per country for population subgroup reported and no attempt was made to compare between sexes or subgroups for age. Data were extracted from individual surveys on the population mean (SD) intake (g/d, ml/d) of FJ in the total population and for consumers only (note: the proportion of consumers (%) was included from individual surveys, only if intake data were available either for the total population or consumers only). Data were also extracted from individual surveys on the mean percent contribution of FJ to energy, total sugars, free sugars, vitamin C, folate and potassium intakes for the total population (i.e., non-consumers plus consumers). For consistency in reporting data from individual surveys, intake data were reported in grams (assuming 1 ml ≡ 1 g) and all data were rounded to the nearest whole number. Crude estimates of population mean intakes of FJ across countries per population subgroup were reported as a range, mean and median for the total population and for consumers only. For each country and population subgroup, the data used were (to the best of the authors’ knowledge) the most recent that had been published prior to August 2023.

Results

Data availability

Of the 53 countries of the WHO EU Region, only 35 had conducted national food consumption surveys (Table 1)(Reference Jakubikova, Dofkova and Ruprich25–87). Of these, 13 countries did not publish their summary data in the online public domain(Reference Sokolić, Kenjerić and Colić-Barić70–87) and a further 8 countries had food consumption data which was unsuitable for inclusion in this review (i.e., did not report FJ intakes separately, did not report population intakes (g/d, ml/d) or included other dietary components in the reporting of FJ intakes)(Reference Jakubikova, Dofkova and Ruprich25–Reference Pedersen, Christensen and Matthiessen33,Reference Brettschneider, Lage Barbosa and Haftenberger37,Reference Gose, Krems and Heuer38,51) . In total, data from 14 countries across Europe were available for inclusion in this review(Reference Lemming and Pitsi34–36,Reference Gunnarsdóttir, Eysteinsdóttir and Þórsdóttir39–Reference Barzda, Bartkevičiūtė and Baltušytė50,52–Reference Astrup, Borch Myhre and Frost Andersen57,Reference Totland, Kjerpesetch Melnæs and Lundberg-Hallén59–63,Reference Amcoff, Edberg and Enghardt Barbieri65–Reference Bates, Lennox and Prentice69) . It is important to note, however, that data were not available for all population subgroups within these 14 countries, few separately reported consumer intake data and not all countries reported the contribution of FJ to energy and nutrient intake data (or did not report this by subgroup).

Table 1. Overview of national food consumption surveys across Europe which reported data on intakes of fruit juice or contribution of fruit juice to energy and nutrient intake, by population group reported

m: months, y: years.

* Denotes where data were sourced from two different surveys.

Countries with no national food consumption survey found for inclusion: Albania, Armenia, Azerbaijan, Belarus, Bosnia & Herzegovina, Georgia, Kazakhastan, Kyrgzstan, Luxembourg, Monaco, Montenegro, Republic of Moldova, San Marino, Serbia, Tajikistan, Turkmenistan, Ukraine, Uzbekistan.

Countries which have conducted national food consumption surveys but did not publish their summary data in the online public domain: Croatia(Reference Sokolić, Kenjerić and Colić-Barić70,Reference Agency, Darja and Martina71) , Cyprus(Reference Yiannopoulos, Ioannou–Kakouri and Kanari72,Reference Yiannopoulos, Ioannou–Kakouri and Kanari73) , Greece(74), Hungary(Reference Csizmadia and Larnsak75,Reference Csizmadia and Larnsak76) , Israel(Reference Kaluski, Goldsmith and Arie77,78) , Latvia(Reference Bior and Siksna79), Poland(Reference Drygas, Niklas and Piwońska80), Romania(Reference Neagu, Nicolescu and Tănăsescu81), Russian Federation(Reference Kozyreva, Kosolapov and Popkin82), Slovakia(83), Slovenia(Reference Blaznik, Gregorič and Delfar84,Reference Gregorič, Blaznik and Delfar85) , The former Yugoslav Republic of Macedonia(Reference Popovska86), Turkey(87).

100 % Fruit juice consumption

Infants, children & teenagers

For infants, FJ intake data were available for 8 countries; France, Iceland, Ireland, Italy, the Netherlands, Norway, Spain and the UK (Table 2)(36,Reference Gunnarsdóttir, Eysteinsdóttir and Þórsdóttir39,43,Reference Leclercq, Arcella and Piccinelli48,52,Reference Borch Myhre, Frost Andersen and Lene Kristiansen55–Reference Astrup, Borch Myhre and Frost Andersen57,62,Reference Bates, Collins and Jones68) . The population mean intake of FJ (across countries) ranged from 9 to 67 g/d (mean: 43 g/d, median: 43 g/d). For infants, data on FJ intakes among consumers were available for 3 countries: Ireland (51 % consumers), Italy (46 %), and Norway (1 %) (France reported 37 % consumers but did not separately report intakes in this group). For infants, the population mean intake of FJ among consumers (across countries) ranged from 15 to 144 g/d (mean: 86 g/d, median: 98 g/d).

Table 2. 100 % Fruit juice intake (g/d) in infants in the WHO European Region, as reported in national food consumption surveys, in the total population and consumers only

* Calculated from data reported on sex/age subgroups weighted using the provided n values to give one value per country per subgroup reported.

m: months, y: years, NR: Not reported, NA: Not available (due to calculated data from sex/age subgroups).

For children, FJ intake data were available for 9 countries: France, Iceland, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden and the UK (Table 3)(36,Reference Gunnarsdóttir, Eysteinsdóttir and Þórsdóttir39–Reference Þórsdóttir and Gunnarsdóttir41,44,52,Reference Lopes, Torres and Oliveira60,62,Reference Warensjö Lemming, Moraeus and Petrelius Sipinen66,Reference Bates, Collins and Jones68) . The population mean intake of FJ (across countries) ranged from 21 to 97 g/d (mean: 63 g/d, median: 75 g/d). For children, data on FJ intakes among consumers were available for 2 countries: Ireland (40 % consumers) and Italy (66 %) (France and Sweden also reported 67 and 26 % consumers, respectively but did not separately report intakes in these groups). For children, the population mean intake of FJ among consumers (across countries) ranged from 94 to 122 g/d (mean: 108 g/d, median: 108 g/d).

Table 3. 100 % Fruit juice intake (g/d) in children in the WHO European Region, as reported in national food consumption surveys in the total population and consumers only

* Calculated from data reported on sex/age subgroups weighted using the provided n values to give one value per country per subgroup reported.

y: years, NR: Not reported, NA: Not available (due to calculated data from sex/age subgroups).

For teenagers, FJ intake data were available for 9 countries: France, Iceland, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden and the UK (Table 4)(36,Reference Þorgeirsdóttir, Valgeirsdóttir and Gunnarsdóttir42,45,Reference Leclercq, Arcella and Piccinelli48,52,Reference Lopes, Torres and Oliveira60,62,Reference Warensjö Lemming, Moraeus and Petrelius Sipinen66,Reference Bates, Collins and Jones68) . The population mean intake of FJ (across countries) ranged from 28 to 107 g/d (mean: 69 g/d, median: 71 g/d). For teenagers, data on FJ intakes among consumers were available for 2 countries: Ireland (30 % consumers) and Italy (71 %) (France and Sweden also reported 63 and 22 % consumers, respectively but did not separately report intakes in these groups). For teenagers, the population mean intake of FJ among consumers (across countries) ranged from 107 to 117 g/d (mean: 112 g/d, median: 112 g/d).

Table 4. 100 % Fruit juice intake (g/d) in teenagers in the WHO European Region, as reported in national food consumption surveys in the total population and consumers only

* Calculated from data reported on sex/age subgroups weighted using the provided n values to give one value per country per subgroup reported.

y: years, NR: Not reported, NA: Not available (due to calculated data from sex/age subgroups).

Adults & older adults

For adults, FJ intake data were available for 14 countries: Estonia, Finland, France, Iceland, Ireland, Italy, Lithuania, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK (Table 5)(Reference Lemming and Pitsi34,36,Reference Þorgeirsdóttir, Valgeirsdóttir and Gunnarsdóttir42,46,Reference Leclercq, Arcella and Piccinelli48,Reference Barzda, Bartkevičiūtė and Baltušytė50,52,Reference Totland, Kjerpesetch Melnæs and Lundberg-Hallén59,Reference Lopes, Torres and Oliveira60,63,Reference Amcoff, Edberg and Enghardt Barbieri65,67,Reference Bates, Collins and Jones68) . The population mean intake of FJ (across countries) ranged from 24 to 115 g/d (mean: 53 g/d, median: 48 g/d). For adults, data on FJ intakes among consumers were available for 5 countries: Finland (29 % consumers), Ireland (39 %), Italy (55 %), Sweden (91 %) and Switzerland (47 %) (France also reported 29 % consumers but did not separately report intakes in this group). For adults, the population mean intake of FJ among consumers (across countries) ranged from 53 to 212 g/d (mean: 137 g/d, median: 128 g/d).

Table 5. 100 % Fruit juice intake (g/d) in adults in the WHO European Region, as reported in national food consumption surveys in the total population and consumers only

* Calculated from data reported on sex/age subgroups weighted using the provided n values to give one value per country per subgroup reported.

y: years, NR: Not reported, NA: Not available (due to calculated data from sex/age subgroups).

For older adults, FJ intake data were available for 13 countries: Finland, France, Iceland, Ireland, Italy, Lithuania, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and the UK (Table 6)(Reference Lemming and Pitsi34,36,Reference Þorgeirsdóttir, Valgeirsdóttir and Gunnarsdóttir42,46,Reference Leclercq, Arcella and Piccinelli48,Reference Barzda, Bartkevičiūtė and Baltušytė50,52,Reference Totland, Kjerpesetch Melnæs and Lundberg-Hallén59,Reference Lopes, Torres and Oliveira60,63,Reference Amcoff, Edberg and Enghardt Barbieri65,67,Reference Bates, Collins and Jones68) . The population mean intake of FJ (across countries) ranged from 13 to 102 g/d (mean: 47 g/d, median: 39 g/d). For older adults, data on FJ intakes among consumers were available for 5 countries: Finland (29 % consumers), Ireland (43 %), Italy (47 %), Sweden (91 %) and Switzerland (47 %) (France also reported 44 % consumers but did not separately report intakes in this group). For older adults, the population mean intake of FJ among consumers (across countries) ranged from 48 to 212 g/d (mean: 132 g/d, median: 128 g/d).

Table 6. 100 % Fruit juice intake (g/d) in older adults (≥65y) in the WHO European Region, as reported in national food consumption surveys in the total population and consumers only

* Calculated from data reported on sex/age subgroups weighted using the provided n values to give one value per country per subgroup reported.

y: years, NR: Not reported, NA: Not available (due to calculated data from sex/age subgroups).

Patterns of fruit juice consumption

Based on the available data, these results show that estimates of population mean intake of FJ was lowest among infants (43 g/d) and highest in children (63 g/d) and teenagers (69 g/d). Intakes among adults (53 g/d) were lower than in children and teenagers with older adults (47 g/d) having similar intakes to infants. Looking at consumers only, infants had the lowest intakes (86 g/d) while adults and older adults had the highest intakes (137 g/d and 132 g/d, respectively) while intakes among children and teenagers were generally similar (108 g/d and 112 g/d, respectively).

Contribution of fruit juice to energy & nutrient intakes

Data on the contribution of FJ to intakes of energy, total sugars, free sugars, vitamin C, folate and potassium were available from 9 countries: Finland, Ireland, Italy, the Netherlands, Norway, Portugal, Sweden, Switzerland and the UK (Table 7)(Reference Valsta, Kaartinen and Tapanainen35,Reference Walton, Kehoe and McNulty47,Reference Sette, Le Donne and Piccinelli49,Reference Van Rossum, Buurma-Rethans and Vennemann53,Reference Sluik, van Lee and Engelen54,Reference Totland, Kjerpesetch Melnæs and Lundberg-Hallén59–Reference Marinho, Severo and Correia61,Reference Amcoff, Edberg and Enghardt Barbieri65–Reference Bates, Lennox and Prentice69) . Most countries provided contribution data by age group (infants, children, teenagers, adults, older adults) while Portugal provided information for the total population (3–84 years)(Reference Lopes, Torres and Oliveira60) (with the exception of information on the contribution to intakes of free sugars(Reference Marinho, Severo and Correia61)) and Ireland provided information on the contribution to intakes of free sugars for adults 18–90 years only(Reference Walton, Kehoe and McNulty47). Across the lifecycle, FJ contributed very small proportions of energy intake (0–3 %). FJ contributed 4–11 % of total sugars intake in infants, children and teenagers, but contributed smaller proportions in adults and older adults (2–8 %). FJ contributed 3–12 % of free sugars intake in infants, children and teenagers with similar contributions in adults and older adults (2–14 %). With respect to contributions to vitamin C, FJ made important contributions across the lifecycle (4–26 % of intake). Across the lifecycle, FJ contributed relatively small proportions of folate (up to 7 %) and potassium (up to 4 %).

Table 7. Contribution (%) of 100 % fruit juice to intakes of energy and nutrients across the lifecycle in the WHO European Region, as reported in national food consumption surveys in the total population

* Calculated from data reported on sex/age subgroups weighted using the provided n values to give one value per country per subgroup reported.

m: months, y: years, NR: Not reported

Discussion

This review has collated FJ consumption data across the lifecycle from nationally representative food consumption surveys in Europe and has examined the contribution of FJ to intakes of energy and key nutrients including total sugars, free sugars, vitamin C, folate and potassium. The review has identified significant gaps regarding the availability of country-specific data relating to FJ consumption for population groups across Europe. It has also highlighted the challenges in interpreting/collating data across countries due to variances in the classification, disaggregation and reporting of both intake and nutritional contributions. Based on crude estimates from the available data (within inclusion criteria), population mean intakes of FJ for the total population were highest in children and teenagers and lowest in infants and older adults. Among consumers only, adults and older adults consumed approximately 1 × 150 ml glass/day (range: 132–137 g/d) which is consistent with some FBDG, with intakes being lower in infants (86 g/d), children (108 g/d) and teenagers (112 g/d)(Reference Herforth, Arimond and Álvarez-Sánchez2,Reference Benton and Young88) . Across the lifecycle, FJ made negligible contributions to total energy intake (<3 %), small contributions to intakes of folate and potassium (up to 7 %) but contributed up to one-quarter of intakes of vitamin C (4–26 %). In addition, FJ contributed to up to 11 % of total sugars intake and 2–14 % of free sugars intake across the lifecycle.

Gaps and challenges

The importance of having recent, high-quality, country-specific, nationally representative food consumption data to inform nutrition policy has been well acknowledged in the literature(Reference Rippin, Hutchinson and Evans22,Reference Rippin, Hutchinson and Jewell89–92) , therefore the first aim of this review was to identify available data on FJ consumption from national food consumption surveys across Europe. This review showed that there are significant gaps in the availability of country-specific data relating to FJ consumption for population groups across Europe. Out of 53 countries within the WHO European region, only 14 had comparable data on FJ consumption for any population subgroup with an underrepresentation of data from Central and Eastern European countries. This highlights significant challenges in setting guidance or policy at European level for FJ or associated nutrient/health outcomes. The lack of available data from national food consumption surveys has been previously highlighted for other food groups and nutrient intakes(Reference Rippin, Hutchinson and Evans22,Reference Walton, Bell and Re23,Reference Micha, Coates and Leclercq90) . Even within the 14 countries, data were not available for all population subgroups (or were not reported by population subgroup) and not all had suitable data e.g., for percent consumers or contributions to energy and nutrient intakes. These points are important to note as policy is set for all population subgroups (i.e. across the lifecycle) and therefore there is a need to have representation of all population subgroups within individual countries and not just across countries within a region.

In the context of this review, beyond gaps in the data, there were also significant challenges within categorisation of data on FJ. Food groups are often reported in such a way that allows meaningful comparisons with country specific FBDG and broadly include groups such as cereals, dairy, meat, fruit, vegetables, fats and discretionary foods. This review found that the categorisation of FJ reported across countries and even across different surveys within the same country were heterogenous with FJ often categorised as part of ‘fruit & fruit juices’ but sometimes categorised as part of ‘non-alcoholic beverages’ and for some countries, it is categorised in both places. Furthermore, between countries, there was a large variation in what was included in the FJ category between countries e.g., the inclusion of nectars, olives, applesauce and smoothies. This raises questions about whether some reported FJ categories are actually measuring FJ consumption and its nutritional role or if they are reporting an overestimate due to the inclusion of other components in the categorisation. Furthermore, it has been highlighted in some studies and policy documents that within individual food consumption surveys and other research studies, participants may not have the knowledge or information to differentiate between FJ with no added sugars and nectars and fruit drinks with added sugars, and/or the questions posed may be insufficiently specific to differentiate between sweetened and unsweetened juices(Reference Allergens and Turck19,Reference Jakubikova, Dofkova and Ruprich25) .

These findings suggest that estimates of FJ intake and nutritional contributions from some countries may be overestimated using current characterisations which may have implications for the development of population-based nutrition policies and re-iterates the need for precise and consistent characterisation of FJ data across Europe.

Estimation of FJ intakes across the lifecycle

The second aim of this review was to use the comparable/homogenous definition of FJ to examine current intakes and the proportion of consumers of FJ and to determine its contribution to intakes of energy, total sugars, free sugars, vitamin C, folate and potassium across the lifecycle in Europe.

Population mean intakes of FJ across the lifecycle for the total population across Europe ranged from 44–71 g/d with intakes generally increasing from infants to teenagers and decreasing in adults and older adults. While few studies have collated and compared data on intakes of FJ, a recent global review of beverage intake in over 187 countries found that adults (20+ years) consumed an average of 0·16 x 8oz servings (∼36 g) of FJ daily with intakes across European regions (Central, East, West) ranging from 20–61 g/d which is similar to our findings for adults and older adults (47–53 g/d)(Reference Singh, Micha and Khatibzadeh5). To the best of the authors’ knowledge, there are no reviews which have provided quantified estimates of FJ intake in children and teenagers between different countries. However, a review of fluid intakes from beverages across age groups (including adults) found that daily fruit & vegetable juice consumption varied globally with consumption decreasing with age(Reference Özen, Bibiloni and Pons93). Both of these reviews defined FJ as ‘beverages containing 100 % fruit or vegetable juice with no added sweeteners’ which is similar to the definition used in the present review.

While FBDG vary across countries, where FJ is included as part of the fruit & vegetable group, it is generally recommended that consumption is limited to <150 ml/d (which can count towards 1 fruit/vegetable portion only per day)(Reference Herforth, Arimond and Álvarez-Sánchez2,Reference McCarthy, Kehoe and Flynn3,94) . This review found that, among consumers, intakes of FJ across the lifecycle were approximately 1 × 150 ml glass/day (range: 132–137 g/d) for adults and older adults, with lower intakes among infants (86 g/d), children (108 g/d) and teenagers (112 g/d). While other FBDG explicitly recommend avoiding FJ (grouping it with sugar-sweetened beverages)(Reference Herforth, Arimond and Álvarez-Sánchez2–4), some studies support the evidence for FJ as an important contributor to overall intakes of fruit & vegetables in all population groups(Reference Byrd-Bredbenner, Ferruzzi and Fulgoni III7,Reference Benton and Young88) This is of particular importance as intakes of fruit and vegetables are consistently below recommendations globally(Reference Hall, Moore and Harper95) with the WHO attributing approximately 16 million disability-adjusted life years and 1·7 million deaths worldwide to these low intakes(96). While this review found that intakes of FJ across the lifecycle in Europe are broadly in line with quantitative guidelines from FBDG which allow for the consumption of FJ, higher intakes have been reported for consumers across all age groups from national food consumption surveys in the US and Brazil (184–249 g/d)(Reference Mitchell, Musa-Veloso and Fallah6).

Nutritional contributions from FJ

FJ is typically low in energy, contains natural fruit sugars, important amounts of key micronutrients including vitamin C, folate and potassium(Reference Ho, Ferruzzi and Wightman97) and by law is not permitted to have added sugars or sweeteners(1). However, the role of FJ in a healthy diet is under scrutiny due to its sugar and dietary fibre content compared to the whole fruit counterpart. Considering this ongoing debate surrounding the role of FJ within FBDG and wider nutrition policies(17–Reference Allergens and Turck19) it is important to consider available data on its contribution to energy and nutrient intakes at population level to better understand its overall dietary role.

This review found that across the lifecycle in Europe, FJ made negligible contributions to total energy intake (<3 %), small contributions to intakes of folate and potassium (up to 7 %) but contributed up to one-quarter of vitamin C intakes (4–26 %) (which promotes the absorption of iron). These data indicate the important role of FJ in the context of vitamin C intakes in population groups with little contribution to energy intakes. They also add to the evidence base for a nutritional role of 100 % FJ, given that other studies report an association between FJ and overall better diet quality including increased intakes of vitamin C, folate and potassium across the lifecycle(Reference Byrd-Bredbenner, Ferruzzi and Fulgoni III7–Reference Bellisle, Hébel and Fourniret11). However, this review also found that FJ contributed 2–11 % of total sugars and 2–14 % of free sugars intake across the lifecycle which is of public health interest as intakes of free sugars globally (including Europe) are higher than recommendations(Reference Walton, Bell and Re23,Reference Azaïs-Braesco, Sluik and Maillot98) . While these findings show a modest contribution of FJ to free sugars, a recent review has shown that sweet products and beverages (excluding FJ) are the major sources of added sugars across Europe (contributing 48–92 % of intakes)(Reference Azaïs-Braesco, Sluik and Maillot98). This highlights the importance of targeting sugar reduction strategies for discretionary/’top-shelf’ foods which are not recommended in FBDG and, unlike FJ, where reformulation is legally possible.

Of note, the findings from this review that FJ contributed to 2–14 % of free sugars intake across the lifecycle differ considerably from the estimation made by EFSA (15–50 % contribution) in the setting of tolerable upper intake levels for sugar(Reference Allergens and Turck19). However, it is important to acknowledge that the values provided by EFSA were firstly for consumers only and secondly included other items such as nectars and FJ with added ingredients in the categorisation(Reference Allergens and Turck19). The findings of the current review are more in line with those reported by the UK SACN which provided more conservative estimates of the contribution of FJ to NMES (8–14 %) at population level(17). This highlights significant challenges in the interpretation of data used for policy making with respect to FJ consumption and dietary guidance. To add to these challenges, FJ has recently been included as a topic of discussion in the context of ultra processed foods (UPF)(Reference Capozzi, Magkos and Fava99), hence it is important to note that the definition of FJ utilised in this review (100 % pure FJ) would be classified as NOVA group 1 ‘minimally processed’ (in comparison to FJ drinks which contain added ingredients)(Reference Monterio, Cannon and Lawrence100).

Conclusion

In conclusion, this review has identified significant gaps regarding the availability of country-specific national food consumption surveys across all population groups and specifically data relating to FJ consumption across Europe. However, using a comparable/homogenous definition of FJ, this review has reported population mean intakes of FJ across Europe were highest in children and teenagers and lowest in infants and older adults. Among consumers, adults and older adults consumed approximately 1 × 150 ml glass/day, which is similar to the amounts recommended in some FBDG, with lower intakes among infants (86 g/d), children (108 g/d) and teenagers (112 g/d). FJ made important contributions to intakes of vitamin C across the lifecycle while making little contribution to energy intakes but also contributed 2–14 % of free sugars intake (which may be considered modest considering reported contributions from low nutrient dense discretionary foods in other studies). Considering the findings of this review and previous studies of the relationship between FJ and health, these data would suggest there is a nutritional role for FJ at current consumption levels across Europe. However, the complexity of collating and interpreting data on FJ intake as elucidated in this review (and noted in other studies) raises questions surrounding the categorisation of FJ in research related to associations with health and may have implications for the development of population-based nutrition policies with respect to FJ consumption and dietary guidance.

Financial support

Funding for this work was provided by the Fruit Juice Science Centre (https://fruitjuicesciencecentre.eu). Fruit Juice Science Centre had no role in the analysis or writing of this review.

Competing interests

JW and LK were paid a fee from the Fruit Juice Science Centre for the production of this manuscript. Fruit Juice Science Centre had no role in the design, analysis or writing of this review.

Authorship

JW and LK collated the data, interpreted the data, drafted the manuscript and read and approved the final version of the manuscript.

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Figure 0

Table 1. Overview of national food consumption surveys across Europe which reported data on intakes of fruit juice or contribution of fruit juice to energy and nutrient intake, by population group reported

Figure 1

Table 2. 100 % Fruit juice intake (g/d) in infants in the WHO European Region, as reported in national food consumption surveys, in the total population and consumers only

Figure 2

Table 3. 100 % Fruit juice intake (g/d) in children in the WHO European Region, as reported in national food consumption surveys in the total population and consumers only

Figure 3

Table 4. 100 % Fruit juice intake (g/d) in teenagers in the WHO European Region, as reported in national food consumption surveys in the total population and consumers only

Figure 4

Table 5. 100 % Fruit juice intake (g/d) in adults in the WHO European Region, as reported in national food consumption surveys in the total population and consumers only

Figure 5

Table 6. 100 % Fruit juice intake (g/d) in older adults (≥65y) in the WHO European Region, as reported in national food consumption surveys in the total population and consumers only

Figure 6

Table 7. Contribution (%) of 100 % fruit juice to intakes of energy and nutrients across the lifecycle in the WHO European Region, as reported in national food consumption surveys in the total population