A study in The Journal of Nutrition has found that early introduction of juice into infants’ diets prior to 12 months of age is associated with sugary beverage intake in early and middle childhood.
In 2017, the American Academy of Pediatrics recommended that 100% fruit juice not be introduced into infants’ diets prior to 12 months of age, if introduced at all. This recommendation is based on concerns that the early introduction of juice and other sweet foods increases the risk of childhood obesity and dental caries. Furthermore, intake of juice at 12 months has also been associated with more 100% fruit juice and sugar-sweetened beverage intake and less water intake in middle childhood. However, the age of juice introduction has not been examined in relation to subsequent beverage intake in early or middle childhood.
To identify correlates of early juice introduction (<6 months) and to determine whether early introduction establishes a pattern of sugary beverage intake in childhood, Edwina Yeung (Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health) and colleagues examined the timing of juice introduction within the context of a longitudinal cohort with prospectively collected information. As the cohort was established prior to the American Academy of Pediatric 2017 guidelines, juice introduction was evaluated based on the old (>6 months) and new (>12 months) recommendations.
This study utilized data from the Upstate KIDS study, a prospective birth cohort with follow-up through 7 years. The age of juice introduction was assessed from responses on questionnaires administered from 4–18 months and categorized as <6, 6 to <12, and >12 months. In addition to sociodemographic information, mothers reported their child’s regular juice, soda, water, and milk intakes at 24, 30, and 36 months and at 7 years of age.
Of the 4067 mothers that responded to the juice introduction question by 18 months, 25% reported introducing juice into their child’s diet at <6 months of age, 49% at 6 to <12 months, and 26% at >12 months. Earlier juice introduction was associated with multiple factors including younger maternal age, black or Hispanic race/ethnicity, lower educational attainment, Special Supplemental Nutrition Program for Women, Infants, and Children participation, smoking during pregnancy, a higher pre-pregnancy body mass index, a lower household income, and living in a townhouse/condominium or mobile home. Earlier juice introduction was related to a higher childhood juice intake, any soda intake, and lower water intake.
In summary, in this prospective cohort study, 75% of mothers reported introducing juice to their child’s diet at >6 months of age, in line with American Academy of Pediatric guidelines at the time of the study. An earlier age of juice introduction was associated with indicators of lower socioeconomic status. Furthermore, earlier juice introduction was related to increased juice and soda intake, as well as less water intake, in early and middle childhood. Taken together, study results suggest earlier juice introduction may be impactful on beverage preferences in childhood, which can exacerbate health disparities. Delaying juice introduction may represent an easier intervention for parents than restricting intake once a child has already demonstrated preferences for juice. As this study was unable to distinguish further between drink types, future studies should examine whether introduction of 100% fruit juice and introduction of juice drinks with added sugars have differing effects on beverage preferences in childhood.
Sonia L Robinson, Rajeshwari Sundaram, Diane L Putnick, Jessica L Gleason, Akhgar Ghassabian, Tzu-Chun Lin, Erin M Bell, Edwina H Yeung, Predictors of Age at Juice Introduction and Associations with Subsequent Beverage Intake in Early and Middle Childhood, The Journal of Nutrition, Volume 151, Issue 11, November 2021, Pages 3516–3523, https://doi.org/10.1093/jn/nxab260.
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