A Prospective Study of Fruit Juice Consumption and the Risk of Overall and Cardiovascular Disease Mortality

There is little evidence for the association between fruit juice, especially 100% fruit juice, and mortality risk. In addition, whether 100% fruit juice can be a healthy alternative to whole fruit remains uncertain. This prospective study utilized the data from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014. After a median follow-up of 7.8 years, 4904 deaths among 40,074 participants aged 18 years or older were documented. Compared to non-consumption, daily consumption of 250 g or more of 100% fruit juice was associated with higher overall mortality (hazard ratio (HR) = 1.30, 95% confidence interval (CI): 1.11-1.52) and mortality from heart disease (HR = 1.49, 95 CI: 1.01-2.21). A similar pattern was observed for total fruit juice, with HRs of 1.28 (95% CI: 1.09-1.49) for overall mortality and 1.48 (95% CI: 1.01-2.17) for heart disease mortality. Replacing 5% of energy from whole fruit with 100% or total fruit juice was associated with a 9% (95% CI: 2-16%) and 8% (95% CI: 1-15%) increased mortality risk, respectively. Our findings suggest that both total and 100% fruit juice could be associated with high mortality risk, and need to be validated in well-designed studies given the potential misclassification of diet and death reasons.