1. Fruit Juice Linked to Childhood Obesity? Evaluation of juice intake and BMI in Ontario preschoolers June 4, 2010 Northern Health Research Conference Sudbury, Ontario Pamela Brunelle, NODIP Janis Randall Simpson, U of G Lee Rysdale, NRC Christopher Knee, U of G Heather Keller, U of G

2. Presentation Outline Background Objectives Methodology Results Future Research Practice Points Questions

3. Background >26% of Canadian children aged 2-17 are overweight or obese. Do specific eating habits play an etiological role? Fruit juice - common beverage of young children –easy to drink –tastes good –parents believe it is a healthy choice High/increased intake of sugar-sweetened drinks (pop, fruit drinks, etc.) are considered a serious obesity risk. Role of 100% fruit juice in promoting excess weight for height is less understood.

4. Background American Academy of Pediatrics –Limit children’s intake of 100% fruit juice to 4-6 oz/ day (125-175 mL/day). –Evaluate fruit juice intake when assessing childhood overweight and obesity. Eating Well with Canada’s Food Guide –Limit fruit-flavoured, soft and sweetened drinks. –One serving of vegetable/fruit juice is 125 mL. –No specific recommendations for the number of juice servings per day.

5. Background Adiposity Rebound Preschool years-critical period for obesity prevention. Children’s Body Mass Index (BMI) is normally lowest around age 4 to 6. “Adiposity rebound” occurs after this age. If “adiposity rebound” occurs before age 5.5 years, increased risk for obesity later in life.

6. Source: http://www.biomedcentral.com/1471-2431/4/6/figure/F1

7. Background No current information on fruit juice intakes of Canadian children. No data to suggest associations with BMI in Canadian preschoolers. Previous studies on the effects of fruit juice on children’s BMI –inconsistent methodologies –contradictory findings –Canadian comparisons difficult

8. Study Objectives 1.Describe 100% fruit juice intake amongst a sample of Ontario preschoolers. 2.Investigate associations between fruit juice and BMI and select child, parental and family characteristics. 3.Provide fruit juice consumption data on a Canadian population for comparative studies and nutrition surveillance.

9. Methodology Secondary data analysis from NutriSTEP ® validation study (May 2005 to January 2006). Sample: 254 preschool children (aged 3-5), living in Ontario communities: –Greater Sudbury and Manitoulin Island –York Region –London area Fruit juice data from three-day food intake records. Children’s weight and height for BMI measured by RD. Demographic characteristics: an 8-item standardized questionnaire from Stats CAN.

10. NutriSTEP ® Nutrition Screening Tool for Every Preschooler Fast and simple way to assess eating habits and identify nutrition problems early. Parent-completed 17-item questionnaire on preschool nutrition risk constructs: –food/nutrient intake –physical growth –developmental and physical capabilities –physical activity and inactivity –food security and the feeding environment Research data extracted from the validation study. www.nutristep.ca

12. Methodology Juice intake cut-points: – 250 mL/day BMI categories: –≤85 th percentile, >85 th percentile Bivariate analyses: –Juice intake –BMI category –Child, parental and family characteristics

13. Results 23.6% of preschoolers were overweight or at risk of being overweight. 88% of children consumed at least some fruit juice. Mean fruit juice intake was 210 mL/day. Over half (57%) consumed more than 125 mL/day. One third (31%) consumed more than 250 mL/ day.

14. Results Figure 1- Preschooler proportions in categories of fruit juice intake and BMI

15. Results No significant differences were seen in fruit juice intake amongst BMI categories. Preschoolers living in homes with 3 or 4 children appeared to consume more fruit juice. The same sample of preschoolers had low consumption of grains (54.3%), fruits (54.6%), vegetables (44.6%), milk and alternatives (24.5%), and meat and alternatives (31.6%).

16. Future Research A larger and more diverse sample is needed. Investigate other associations between juice consumption and key nutrients. Determine role of overall beverage consumption in total energy intake and weight status in the preschool years. Measure parental nutrition knowledge and attitudes and determine the ability of these characteristics to predict children’s eating habits.

17. Practice Points Fruit juice intake may influence quality and consumption of other beverages. Support and educate parents: –CFG including child-size servings –Offer juice and milk during or at the end of meals –Water in between meals

18. Conclusions Results support many previous studies. 100% fruit juice consumption does not appear to be associated with children’s BMI. Longitudinal diet research with more ethnically and socially- economically diverse parents of preschoolers is recommended.

19. Rysdale LA, Brunelle PL, Randall Simpson JA, Knee CA, Keller HH. Evaluation of fruit juice intake and Body Mass Index within a sample of Ontario preschoolers. Infant, Child, & Adolescent Nutrition (2009); 1 (3): 170-175

20. Acknowledgements Co-authors, University of Guelph –Dr. Janis Randall Simpson –Christopher Knee –Dr. Heather Keller Manuscript Reviewers –Joanne Beyers, Sudbury & District Health Unit –Mary Turfryer, York Region Health Department NutriSTEP ® name and logo are owned by the Sudbury & District Health Unit.

21. Questions?