100% FJ was viewed more as a ‘healthy complement’ to fruit and vegetable intake (67%) than as an ‘alternative’ to these foods (46%). This is in line with the view in several countries that one serving of 100% FJ counts towards targets for fruit and vegetable consumption. Interestingly, acceptance of the ‘alternative’ view was highest in Nordic countries which do not acknowledge 100% FJ as a portion of fruit in national dietary guidelines. Younger HCPs (under 35 years) were less likely to accept that 100% FJ is an ‘alternative’ to fruit (30% versus 49% of HCPs aged over 50 years).
Processed versus fresh
While fresh juice is typically seen as nutritionally better than packaged 100% FJ, this is not always the case. For example, in a randomised cross-over trial, the flavanone content of processed 100% orange juice was higher than that seen in freshly squeezed orange juice (58 mg vs. 16 mg), resulting in a higher bioavailability in human subjects. In addition, carotenoids, vitamin C and folate are all bioavailable in packaged 100% orange juice. Studies comparing orange juice with whole oranges have reported a higher bioavailability of carotenoids and flavanones in the juice, possibly due to the lower fibre content.
Overall, 70% of HCPs agreed that processed 100% orange juice was either very or quite good but nutritionists and dietitians held a more negative view than medics (62% agreeing). A summary of HCPs’ views about processed 100% orange juice is given in Figure 1.
As shown in Figure 1, 85% of HCPs believe that 100% FJ contributes to high levels of sugar in the diet. While 100% FJ is clearly a source of sugar, the contribution to overall intakes is relatively modest compared with other sources, probably because average intakes are less than 100 ml daily and most people do not consume 100% FJ on most days of the week. European data suggest that 100% FJ provides 1-12% of added/free sugar in the diet14 while the UK’s National Diet and Nutrition Survey (NDNS) reported a contribution of 8% for adults and 11-14% for children (in comparison, sugar, preserves and confectionery contribute 16-25%).
A secondary analysis of the UK NDNS found that adults who consumed 1-150 ml of 100% FJ daily had sugar intakes of 11.9% energy compared with 10.6% in non-consumers (p<0.05). However, teenagers had similar sugar intakes (14-15% energy) regardless of whether they consumed up to 150 ml 100% FJ daily. This suggests that avoidance of 100% FJ does not lead to low sugar intakes. In the French Comportements et Consommations Alimentaires en France survey, free sugar intakes were 11.3% of daily energy intake in 100% FJ consumers versus 8.7% in non-consumers, although juice consumers also ate more sweetened yoghurt, cakes, fruit desserts, biscuits and breakfast cereals which would have contributed significantly to sugar intakes.
In the IPSOS survey, there were strong misconceptions about the purity of orange juice. Bizarrely, given the descriptor, only 69% were sure that ‘100% orange juice’ contained just 100% orange juice, although 53% correctly said that no sugar had been added. Only 33% knew that preservatives are not added to 100% FJ. Dietitians and nutritionists had a greater degree of knowledge compared with GPs and paediatricians. Turning to bioactive compounds, only 30-40% of HCPs correctly identified that carotenoids and flavonoids were present in 100% orange juice. Again, dietitians and nutritionists were more likely to understand the nutritional composition of 100% FJ than medics.
Concerns about the contribution of 100% FJ to overall sugar intakes and incorrect beliefs that 100% FJ contains added sugar tended to overshadow positive views about the potential health benefits associated with drinking moderate amounts. For example, HCPs with the strongest views on sugar were less likely to agree that 100% FJ is a good source of micronutrients, can be part of a balanced diet, or that it counts as one portion of fruit. The results of this analysis are summarised in Figure 2.