Young Children’s Consumption of 100% Fruit Juice by Racial-Ethnic Characteristics of Their Mothers

Congress authorized the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) as a pilot program in 1972 and made WIC permanent in 1974. Administered by the Food and Nutrition Service (FNS) of the U.S. Department of Agriculture (USDA), WIC supports the nutritional needs of pregnant, post-partum, 母乳喂养的妇女和从出生到5岁的儿童都生活在低收入家庭，面临营养风险. WIC offers nutritious supplemental foods, nutrition education, and referrals for healthcare services.  Currently, the program is the third-largest nutrition assistance program in the U.S. In 2020, WIC served about 7 million women, infants, and children, with children between the ages of 1 and 5 years making up half of the WIC population.1

美国农业部FNS资助了一项关于出生前后参加WIC的儿童营养和健康结果的研究- WIC婴幼儿喂养实践研究-2 (WIC itfp -2)。. Designed and administered by 趣赢平台, WIC ITFPS-2 followed children from birth through age 6 years, regularly collecting information from mothers2 on the foods and beverages that their children consume during 24-hour periods.  Though all WIC ITFPS-2 participants were enrolled in WIC around the time of the child’s birth, families did not need to continue participating with WIC to stay with the study.

Key Highlights

Based on analysis of dietary recall information from a nationally representative sample of children in families with low incomes:

• The typical preschooler who drinks 100% fruit juice overconsumes.
• The risks of children overconsuming 100% fruit juice differs significantly across racial-ethnic subpopulations.
• 喝100%果汁的儿童比不喝果汁的儿童更有可能达到建议的水果总摄入量.

Context for this analysis

Recently, 趣赢平台的工作人员与饮食质量研究人员合作，研究随着新的儿童饮食建议的实施，总饮食质量的测量可能会发生怎样的变化.3  The analysis suggested that the 100% fruit juice recommendations from the 2020–2025 Dietary Guidelines for Americans (DGA) may differentially impact diet-quality estimates when the data are examined by racial-ethnic groups. This issue brief elaborates on findings implicit in that article, placing the discussion of 100% fruit juice within the context of current recommendations and proposed WIC food packages.

WIC food package for children. The current WIC food package for children between the ages of 1 and 5 years includes a maximum allowance for juice, either 100% fruit or vegetable, of 128 fluid ounces (fl. oz.), which translates into just over 4 fl. oz. of 100% fruit juice per day in a typical month (Figure 1).4 In November 2022, FNS proposed revising the contents of the food packages it offers. Reducing the amount of 100% juice offered to 64 fl. oz. for children and allowing participants to substitute whole fruits and vegetables in lieu of the 64 fl. oz. of 100% juice were among the proposed revisions.5 This proposal means that the revised food package would provide for about 2 fl. oz. of 100% fruit juice per day in a typical month. Because WIC food packages seek to support optimal nutrition, it is important to understand the context for this proposal.

Recommendations for consumption. Since 2001, 美国儿科学会(AAP)建议限制幼儿100%饮用果汁:1至3岁的儿童饮用果汁不应超过4升. oz. of 100% fruit juice per day and children ages 4 to 6 years should consume no more than 6 fl. oz. a day.6 As justification, AAP cites detrimental effects of overconsumption ranging from increased risk of dental caries to inappropriate weight gain.7 The 2020–2025 DGA embraced limiting 100% fruit juice for children in the second year of life (i.e., between 12 and 23 months), but did not put forward specific limits for children ages 2 years and older.8 Instead, 2020-2025年的DGA建议所有2岁及以上的人，个人总水果摄入量的一半以下来自100%的果汁. 2020-2025年DGA和提议的WIC食品包装的讨论都认识到，100%果汁的纤维含量与全水果的纤维含量不同, and fiber is generally underconsumed by Americans.

Levels of 100% fruit juice intake

WIC ITFPS-2 data indicate that mean consumption of 100% fruit juice was 6.1 fl. oz. on a given day for study children at age 2 (Figure 2). At age 5,9 mean consumption was 5.9 fl. oz. on a given day. At all ages, median consumption on a given day was lower than mean, indicating that there were some children who drank a lot more 100% fruit juice than others. Quartile analysis of children’s intakes found that at ages 2 and 5, consumption was at least 8 fl. oz. for those in the top quartile and 0 fl. oz. for children in the bottom quartile. In other words, the top 25 percent of children drank at least 1 cup of juice, while the lowest 25 percent drank none.

There appeared to be differences in the levels of children’s consumption when analyzed by the racial- ethnic characteristics of their mothers; however, only those differences at age 2 were statistically significant (Figure 2). At age 2, children with non-Hispanic Black mothers consumed an average of 7.8 fl. oz. on a given day, while children with non-Hispanic White mothers consumed an average of 5.9 fl. oz., and children with Hispanic mothers consumed an average of 5.5 fl. oz.  At age 5, children with non-Hispanic Black mothers consumed an average of 6.8 fl. oz. on a given day, while children with non-Hispanic White mothers consumed an average of 5.4 fl. oz., and children with Hispanic mothers consumed an average of 6.0 fl. oz. Across the 4-year period, consumption was relatively stable: on average, children in this low-income population drank about 6 fl. oz. of juice on a given day at age 2 and continued to do so through age 5. Regardless of measure used (mean or median), the typical child consumed either at or above the upper limit of the AAP recommendation at ages 2 and 3. By age 4, median consumption was compliant with AAP guidance, but mean consumption for some subgroups continued to exceed the recommendation.

100% fruit juice consumption relative to the DGA recommendation

As mentioned, the DGA recommends that no more than half of total fruit consumption come from 100% fruit juice. 检查100%果汁对水果总消费量的贡献显示，无论母亲的种族-民族特征如何，贡献都接近DGA建议的上限(50%)(图3)。. On average, 非西班牙裔黑人母亲的2岁和3岁儿童100%饮用果汁的比例超过了建议上限. At all ages, differences between non-Hispanic Black and non- Hispanic White subgroups were statistically significant.

Because some children do not consume any 100% fruit juice, including these children in the analysis can hide important subgroup differences. We found that 30 percent of the children did not consume 100% fruit juice on a given day at age 2. At this age, 非西班牙裔白人母亲的孩子比非西班牙裔黑人母亲的孩子更有可能成为不消费的人, and children with Hispanic mothers were significantly more likely than children with non-Hispanic White mothers to be nonconsumers. At age 5, 38 percent did not consume 100% fruit juice on a given day, and children with Hispanic mothers were significantly more likely than children with non-Hispanic White mothers to be nonconsumers.

对100%饮用果汁的儿童的饮食摄入量进行的四分位数分析表明，最高四分位数的儿童至少饮用12升果汁. oz. on a given day at each age, 2 through 5. Children in the lowest quartile drank up to 4 fl. oz. on a given day at ages 2 and 3 and up to 4.9 fl. oz. at ages 4 and 5.

对饮用100%果汁的母亲的果汁对水果总摄入量的贡献的研究表明，无论母亲的种族特征如何，平均贡献通常超过水果总摄入量的50%(图4)。. Children with non-Hispanic Black mothers exhibited the largest average contribution at each age. However, after adjusting for multiple comparisons, 只有非西班牙裔黑人母亲的孩子和西班牙裔母亲的孩子在2岁和5岁时有统计学上的显著差异.10

The DGA recommendation for total fruit

The 2020–2025 DGA recommendations for total fruit intake differ by a child’s age and activity level. The recommendation for a moderately active 2-year-old is 1 cup-equivalent of fruit per day. The recommendation for a moderately active 5-year-old is 1.5 cup-equivalent of fruit per day. Assuming that calories consumed were commensurate with activity levels, 儿童达到DGA建议的总水果摄入量的百分比明显不同于儿童在某一天是否饮用100%的果汁. 喝100%果汁的儿童比不喝这些饮料的儿童更有可能达到当天的水果摄入量建议(图5)。.  Thus, 100% fruit juice consumption helped many children achieve the recommended level of intake based on one day of intake.

Summary

我们对低收入家庭中具有全国代表性的一组幼儿的100%果汁消费量进行了分析，发现饮用100%果汁的典型儿童在某一天过量饮用果汁. Generally, when racial-ethnic differences were significant, 非西班牙裔黑人母亲的孩子比其他种族的母亲的孩子有更大的过度消费风险.

USDA FNS的实际任务是在多种营养援助项目的背景下支持幼儿的营养需求，这些项目为学龄前儿童提供食品和饮料. Given consumption patterns evident in the WIC ITFPS-2 data, consumption of 100% fruit juice helps many children achieve recommended levels of fruit intake, but risks of overconsuming juice may be unequal across racial- ethnic subpopulations within the WIC community.  这些考虑表明，建议对WIC食品包装中100%果汁成分的修订可能会寻求平衡这些饮料的健康益处和过度消费风险.

Acknowledgments

The author would like to thank all of those who contributed to the analyses and offered comments on this Issue Brief. Brenda Sun programmed the analyses in SAS. Amanda Reat, Shannon Whaley, Lorrene Ritchie, Thea Zimmerman, Elizabeth Gearan, Allison Hyra, and Timothy Mulcahy provided helpful comments throughout the process.

About the author

Christine Borger, PhD, a senior economist at 趣赢平台, is the Principal Investigator on the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2). She plans and implements all analyses for this landmark study funded by the U.S. Department of Agriculture, Food and Nutrition Service. In addition to a deep understanding of the WIC program, her areas of expertise include statistical modeling, which she regularly uses to assess relationships between dietary intakes and health outcomes. Dr. Borger is a co-author of a recent article in The Journal of Nutrition 该研究考察了幼儿饮食质量的不同衡量标准，并可能对了解哪些人群未来有患饮食相关疾病的风险产生影响.

Endnotes

1. Kline, N., Zvavitch, P., Wroblewska K., Worden, M., Mwombela, B., and Thorn, B. (2022). WIC participant and program characteristics 2020. Washington, DC: U.S. Department of Agriculture, Food and Nutrition Service. Available at: http://fns-prod.azureedge.us/sites/default/files/ resource-files/WICPC2020-1.pdf.
2. Nearly all adult study participants were biological mothers of the children; however, the children’s primary caregivers — regardless of gender or filial relationship — were respondents.
3. Kay, M., Duffy, E., Sun, B., and Borger, C. (2023). 比较低收入24月龄幼儿的饮食质量指数:探索2020-2025年美国人膳食指南(DGA)推动的变化. The Journal of Nutrition, 153(6). Available at http://www. sciencedirect.com/science/article/pii/S0022316622131342.
4. Food and Nutrition Service (USDA). (n.d.). WIC food packages — regulatory requirements for WIC-eligible foods. Available at: http://www.fns.usda.gov/wic/wic-food-packages- regulatory-requirements-wic-eligible-foods#JUICE%20(Women%20 and%20Children).
5. Food and Nutrition Service (USDA). (n.d.). WIC: Revisions in the WIC food packages. Available at: WIC: Revisions in the WIC Food  Packages | Food and Nutrition Service (usda.gov).
6. Abrams, S.A. (2017). Weighing in on fruit juice: AAP now says no juice before age 1. AAP News. Available at: http://publications.aap. org/aapnews/news/14804.
7. Heyman, M.B., Abrams, S.A., Heitlinger, L.A., Cabana, M.D., Gilger, M.A., Gugig, R., Hill, I.D., Lightdale, J.R., Daniels, S.R., Corkins, M.R., de Ferranti, S.D., Golden, N.H., Magge, S.N., and Schwarzenberg, S.J. (2017). Fruit juice in infants, children, and adolescents: Current recommendations. Pediatrics, 139(6). Available at: http:// publications.aap.org/pediatrics/article/139/6/e20170967/38754/ Fruit-Juice-in-Infants-Children-and-Adolescents.
8. U.S. Department of Agriculture. (2020). Dietary guidelines for Americans. Washington, DC: Author. Available at: http://www. dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_ for_Americans_2020-2025.pdf.
9. At age 5, children are no longer age-eligible for WIC benefits. The data on 5-year-olds were collected from 14 days prior to the child’s fifth birthday to 28 days after. It is possible that some children interviewed at this time were receiving WIC food packages and some were not.
10. We used Bonferroni correction to adjust for multiple comparisons.