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Am Fam Physician. 2007;75(10):1549-1557

Background: Whether consumption of fruit juice leads to adiposity in children is controversial. Faith and colleagues surveyed low-income families to assess this relationship. They also sought to define relationships between fruit and vegetable consumption and weight, and parental restriction of food and adiposity, and to determine the effect of counseling in the Women, Infants, and Children (WIC) nutrition program.

The Study: The investigators surveyed WIC participants and followed weight changes in children one to five years of age for 18 to 48 months. Surveys assessed consumption of milk, fruit juice, and fruit and vegetables per day. Surveys also included questions about whether the participating parent attempted to limit the amount the child ate, whether dessert was contingent on eating the main meal, and whether the parent urged the child to eat more fruits and vegetables. In the final year of the study, the survey asked questions about what nutritional counseling was provided at WIC sessions. The height and weight of participants were obtained from WIC charts, and body mass index was calculated for children older than two years.

Results: Children consumed equal amounts of juice and milk. Boys consumed more milk and were more likely to consume reduced fat milk. Parents were significantly more likely to restrict girls' food intake. Many differences in food choices were noted among ethnicities.

On initial evaluation, the authors found that children who were at risk or overweight were less likely to consume 2% or whole milk and more likely to have their parents restrict their food. A multivariate analysis also found that increased juice consumption was associated with greater weight gain; however, in another statistical model, this association remained only for children who were initially at risk or overweight and it affected boys more than girls.

In this model, offering fruit more often was associated with less weight gain. There also was a trend suggesting that parental restriction of food intake was associated with greater weight gain. WIC counseling had no effect on weight.

Conclusion: The authors conclude that, in this low-income population, and in children who are already obese or at risk of becoming obese, fruit juice consumption contributes to worsening obesity. Nonoverweight children do not appear to be affected. Offering whole fruit in initially overweight children has a beneficial effect on weight gain. In spite of a baseline observation associating low-fat milk consumption with overweight, it does not result in excess weight gain over time.

The authors found that WIC counseling has no impact on weight changes, suggesting that the types of food distributed by WIC are greater determinants of weight than the counseling discussions. The Institute of Medicine and the Department of Agriculture recommend decreasing the juice benefit for WIC recipients and increasing whole vegetable and fruit allotments.

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Copyright © 2007 by the American Academy of Family Physicians.

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