New Study: Pure fruit juice and fruit consumption and the risk of CVD: the European Prospective Investigation into Cancer and Nutrition–Netherlands (EPIC-NL) study

There is strong evidence to suggest that fruit and vegetable consumption reduces the risk of a variety of diseases including cardiovascular disease (CVD). The World Health Organization (WHO) recommends that individuals should consume at least 400g of fruit and vegetables daily, this led to the ‘5 a day’ campaign in the UK.

For some, consuming fruit juice as part of the recommended fruit and vegetable intake may make it more achievable. However, whether fruit juice is an acceptable alternative to whole fruit and carries the same health benefits as whole fruit, remains unclear.

Guidelines for fruit juice consumption varies between countries. For example, the US state that half of daily fruit intake can be met by consuming fruit juice, whereas in the UK individuals are advised to only consume 150ml of fruit juice daily (contributing to 1 of the 5 a day). While consumption is recommended to be kept to a minimum in the Netherlands, mainly due to its high sugar content.

A recent prospective cohort study in the Netherlands aimed to investigate the association of pure fruit juice and whole fruit consumption with CVD.

(Note: pure fruit juice includes both fresh and bottled from concentrate and is defined as 100% fruit juice without additional sugars, artificial sweeteners/colours/preservatives.)

Dietary intake of 34,560 participants (74% female) from the European Prospective Investigation into Cancer and Nutrition-Netherlands (EPIC-NL) study was estimated using a validated food frequency questionnaire (FFQ).

Morbidity data from the national hospital discharge register was linked to the EPIC-NL cohort.

Those who were fruit juice drinkers were more typically ‘healthier’ females, i.e. more likely to be physically active, have a lower BMI and waist circumference, lower blood pressure and have healthier dietary habits, compared to the reference group. Similarly, those consuming high levels of fruit had comparable traits to fruit juice drinkers although tended to be younger, compared to the reference group.

The study found that after adjusting for a variety of factors including age, sex and education, consuming up to 7 glasses of fruit juice a week significantly reduced the risk of CVD by 12-15% and CHD by 14-17% when compared to non-consumers. Moderate consumption of fruit juice was also associated with 20-24% reduced risk of stroke. Fruit consumption significantly lowered the risk of CVD.

Fruit juice is a source of vitamins and polyphenols such as flavonoids. Observational studies suggest flavonoids may reduce the risk of CVD and CHD. The presence of polyphenols and vitamins could go some way to explaining the reduced risk of CVD found in this study. Potential mechanisms include: antioxidant activity, improving endothelial function, and reducing inflammation.

However, the further research is required to better understand the effects of pure fruit juice on CVD as well as other health outcomes. It is still recommended that whole fruit should be preferred over fruit juice.

To access the full paper please use this link.