ABSTRACT
Background
This systematic review was conducted by the 2025 Dietary Guidelines Advisory Committee as part of the process to develop the Dietary Guidelines for Americans, 2025-2030. The U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) appointed the 2025 Dietary Guidelines Advisory Committee (Committee) in January 2023 to review evidence on high priority scientific questions related to diet and health. Their review forms the basis of their independent, science-based advice and recommendations to HHS and USDA, which is considered as the Departments develop the next edition of the Dietary Guidelines. As part of that process, the Committee conducted a systematic review with meta-analysis with support from the USDA Nutrition Evidence Systematic Review (NESR) team to answer the following question: What is the relationship between 100% juice consumption and growth, body composition, and risk of obesity? This review is an update to an existing review that was conducted by the 2020 Dietary Guidelines Advisory Committee.
Methods
The Committee conducted a systematic review with meta-analysis using the methodology of the USDA NESR team. The Committee first developed a protocol. The intervention/exposure was 100% juice consumption in infants and young children up to age 24 months, children, adolescents, adults, older adults, and individuals during pregnancy and postpartum. The comparators were consumption of a different amount of 100% juice (including no consumption and versions diluted with water), water, and solid (e.g., whole fruit), and the outcomes were measures of Growth (in infants and young children up to age 24 months, children, and adolescents) including: height, length/stature-for-age, weight, weight-for-age, stunting, failure to thrive, wasting, BMI-for-age, weight-for-length/stature, body circumferences (arm, neck, thigh), head circumference; Body composition (in infants and young children up to age 24 months, children, adolescents, adults, older adults) including: skinfold thickness, fat mass, ectopic fat, fat-free mass or lean mass, waist circumference, waist-to-hip-ratio; Risk of obesity (in children, adolescents, adults, older adults) including: BMI, underweight, normal weight, overweight and/or obesity, weight loss and maintenance (in adults and older adults); Pregnancy and postpartum-related weight change (in individuals during pregnancy or postpartum) including: gestational weight gain and postpartum weight change. Additional inclusion criteria were established for the following study characteristics: a) use randomized or non-randomized controlled trial, prospective or retrospective cohort, nested case-control, or Mendelian randomization study designs, b) be published in English in peer-reviewed journals, c) be from countries classified as high or very high on the Human Development Index, and d) enroll participants with a range of health statuses. The review excluded intervention studies less than 12 weeks in duration (in children, adolescents, adults, and older adults).
NESR librarians conducted a literature search in PubMed, Embase, CINAHL, and Cochrane to identify articles published between January 2000 and May 2023. Two NESR analysts independently screened all electronic results and the reference lists of included articles based on the pre-determined criteria. The results of this search were combined with included articles from the existing review.
NESR analysts extracted data, from each included article, with a second analyst verifying accuracy of the extraction. Two NESR analysts independently conducted a formal risk of bias assessment, by study design, for each included article, then reconciled any differences in the assessment. Additionally, for studies conducted in infants, children, and adolescents, NESR analysts and biostatisticians converted eligible results to a common effect size and completed meta-analyses, assessments of heterogeneity, and assessments of non-reporting bias, according to the synthesis plan. The Committee qualitatively synthesized the evidence, from all included articles identified in the updated literature search and from the existing review and also considered results from meta-analyses, with attention given to the overarching themes or key concepts from the findings, similarities and differences between studies, and factors that may have affected the results. The Committee developed conclusion statements and graded the strength of evidence based on its consistency, precision, risk of bias, directness and generalizability.
Results
Infants, children, and adolescents
Conclusion statement and grade: A conclusion statement cannot be drawn about the relationship between 100% juice consumption by infants and young children, up to age 24 months, and outcomes related to growth patterns, body composition, and risk of obesity during childhood because of substantial concerns with consistency and precision in the body of evidence. (Grade: Grade Not Assignable)
Summary of the evidence:
• Four articles examined 100% juice consumption and growth, body composition, and risk of obesity. All 4 were prospective cohort studies.
• The articles were synthesized as part of another systematic review on complementary feeding and growth, body composition, and risk of obesity.*
Conclusion statement and grade: 100% juice consumption by children and adolescents is not associated with growth, body composition and risk of obesity. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)
Summary of the evidence:
• Twenty-nine articles met the inclusion criteria for this review. One was from a randomized controlled trial and 28 were from prospective cohort studies. Sixteen of these articles were included in meta-analyses. Four articles were from studies conducted in infants and young children up to age 24 months; only one of these was included the meta-analysis.
• Most articles reported a null relationship between 100% juice and the outcomes of interest; sizes of effects were mainly consistent across studies. Meta-analysis results showed consistency in the direction and magnitude of findings across analyses and low heterogeneity.
• There were some concerns with risk of bias, especially related to confounding and missing data in observational studies.
• The evidence applies to the U.S. population but may not apply to diverse subgroups based on race and/or ethnicity. There were a small number of studies in infants and young children, which limited the ability to draw conclusions about the relationship of 100% juice to growth, body composition, or risk of obesity outcomes in this population.
Adults and older adults
Conclusion statement and grade: 100% juice consumption by adults and older adults is not associated with body composition. This conclusion statement is based on evidence graded as moderate. (Grade: Moderate)
Summary of the evidence:
• Eleven articles examined 100% juice and body composition. Three articles were from randomized controlled trials and 8 articles were from prospective cohort studies. Evidence in adults and older adults was synthesized together.
• Results from trials were consistent, with all trials finding no effect of 100% juice consumption on body composition. The observational data were also consistent, with all studies finding no association between 100% juice consumption in adults and body composition.
• Most of the randomized controlled trials had small sample sizes. Observational studies used varying metrics to measure 100% juice consumption, making comparison of effect sizes and confidence intervals difficult.
• There were some concerns with risk of bias, related to lack of information on randomization or concealment in trials and confounding and missing data in observational studies.
• The evidence applies to the U.S. population but may not apply to diverse subgroups based on weight status, race and/or ethnicity, and socioeconomic position.
Conclusion statement and grade: 100% juice consumption by adults and older adults may not be associated with weight gain. This conclusion statement is based on evidence graded as limited. (Grade: Limited)
Summary of the evidence:
• Fifteen articles met the inclusion criteria for this review. Four were from randomized controlled trials and 11 were from prospective cohort studies. Evidence in adults and older adults was synthesized together.
• Results from trials were consistent, with most demonstrating no effect of 100% juice consumption on weight. Observational data were less consistent for weight.
• All trials had short durations (12 weeks to 3 months) and had small sample sizes. Trials were inconsistent in the type of juice assessed. Observational studies used varying metrics to measure 100% juice consumption, making comparison of effect sizes and confidence intervals difficult.
• There were some concerns with risk of bias, especially related to confounding and missing data in observational studies.
• The evidence applies to the U.S. population but may not apply to diverse subgroups based on weight status, race and/or ethnicity, and socioeconomic position.
Individuals during pregnancy
Conclusion statement and grade: A conclusion statement cannot be drawn about the relationship between 100% juice consumption during pregnancy and adequacy of gestational weight gain because there is not enough evidence available. (Grade: Grade Not Assignable)
Summary of the evidence:
• One article met the inclusion criteria for this review in individuals during pregnancy.
• The 2025 Committee was not able to draw a conclusion because there was not enough evidence available.
Individuals during postpartum
Conclusion statement and grade: A conclusion statement cannot be drawn about the relationship between 100% juice consumption during postpartum and postpartum weight change because there is not enough evidence available. (Grade: Grade Not Assignable)
Summary of the evidence:
• One article from a prospective cohort study met the inclusion criteria for this review in individuals during postpartum.
• The 2025 Committee was not able to draw a conclusion because there was not enough evidence available.