Field Notes

Fruit Juices Linked to Higher Risk of Developing Type 2 Diabetes Among Boys

A small, long-term study of almost 500 children in Massachusetts has found that regularly drinking sugary drinks and 100% fruit juices during childhood and adolescence may be linked to a higher risk of developing type 2 diabetes among boys than girls, according to preliminary research presented at the American Heart Association’s Epidemiology and Prevention│Lifestyle and Cardiometabolic Scientific Sessions 2024.

“While these findings are preliminary, they support the existing evidence about the potential relationship between beverages with added sugar and long-term risk of type 2 diabetes in children,” says lead investigator Soren Harnois-Leblanc, PhD, RD, a postdoctoral researcher in the department of population medicine at Harvard Pilgrim Health Care Institute and Harvard Medical School, both in Boston. “Pediatricians and other health care professionals should caution young patients and their parents about sugary drinks and fruit juices when discussing healthy eating habits.”

According to a 2022 American Heart Association fact sheet about sugary drinks, nearly two-thirds of children and adolescents in the United States consume at least one sugary drink, such as soda, lemonade, or an energy drink, each day. It also notes that in addition to weight gain, eating too many foods with added sugars, especially from sugary drinks, raises the risk of developing heart disease, high blood pressure, type 2 diabetes, and tooth decay.

Using data from Project Viva, an ongoing long-term study of women and their children in eastern Massachusetts that began in 1999, researchers explored whether drinking sugary drinks, 100% fruit juices, and eating fresh fruits were associated with markers for developing type 2 diabetes. Researchers calculated the average consumption of sugary drinks, 100% fruit juices, and fresh fruits over childhood and adolescence based on dietary records and assessed their potential associations with three markers of type 2 diabetes: insulin resistance, fasting blood glucose level, and HbA1c levels. These markers were measured by a single blood test while fasting in late adolescence (approximately age 17).

The analysis found the following:

Each daily serving of sugary drinks (approximately 8 oz) during childhood and adolescence among boys was associated with a 34% increase in insulin resistance, a 5.6 mg per deciliter increase in fasting glucose levels, and a 0.12% increase in HbA1c levels in late adolescence.
Drinking 100% fruit juice throughout childhood and adolescence was linked to a 0.07% increase in HbA1c levels in late adolescence per daily serving of 100% fruit juice among the boys in the study, with only a slight increase in girls of 0.02%.
Eating fresh fruit during childhood and adolescence didn’t appear to have a positive or negative effect on the risk of developing type 2 diabetes among the boys or girls in the study, according to Harnois-Leblanc.

The associations between regularly drinking sugar-sweetened beverages and insulin resistance, fasting blood glucose levels, and elevated HbA1c levels among boys persisted when other health, family, and social factors were considered. These factors included socioeconomic status, child’s and mother’s BMI, mother’s age at time of child’s birth, maternal and paternal history of type 1 or type 2 diabetes, overall diet quality, and other lifestyle behaviors.

“Although several aspects of biology and behaviors differ between boys and girls, I would have expected to also find an association between sugar-sweetened beverages and fruit juice intake and the increases in insulin resistance, glycemia, and HbA1c levels in late-adolescent girls. I was also surprised that eating whole fruits didn’t reduce the levels of these markers of type 2 diabetes,” Harnois-Leblanc says.

“The next steps are to use more advanced statistical tools to enable us to better understand the potential causal role of sugary drinks and fruit juices, and to examine whether the relationships may also differ among children by race and/or ethnicity.”

Study background and details include the following:

Researchers analyzed data of children from the 2,128 pregnant women who had children while enrolled in Project Viva. It found 972 of the children met the criteria for inclusion in this study (parent-completed questionnaires at the child’s age-three examination and no personal or parental history of type 1 or type 2 diabetes, assessed separately from parental history of type 2 diabetes). Of the 972 children, 455 had a fasting blood sample collected at a research visit in late adolescence, Harnois-Leblanc notes.
The study had 240 girls and 215 boys.
Project Viva is a long-term study of women and their children in eastern Massachusetts that began enrollment in 1999. The study is focused on improving maternal and child health by examining the potential impact of various life and health factors during and after pregnancy on the mother’s health and their children’s health, including a review of diet and nutrition. Children were followed from birth to late adolescence, up to age 20 at the most recent follow-up.
Researchers evaluated the frequency of drinking sugary drinks, fruit juices, and eating fresh fruit (based on standard serving sizes) from questionnaires completed by the parent at the child’s age of approximately 3, 8, and 13 years old, and measured fasting blood glucose, insulin, and HbA1c levels in late adolescence (average age of 17.4 years).

The study had several limitations. Although it found an association between regularly drinking sugary drinks and fruit juices and the development of markers for type 2 diabetes, it couldn’t prove that the drinks caused type 2 diabetes. In addition, the relatively small number of study participants may have affected the strength of the association found between sugary drinks and fruit juices and the increased risk of developing type 2 diabetes.

“Diet and cardiometabolic health are complex, with many factors varying over time and interacting in different ways, and this study represents one small piece of this puzzle,” Harnois-Leblanc says.

American Heart Association nutrition committee member Penny M. Kris-Etherton, PhD, RD, FAHA, says, “This study has shown that greater sugar-sweetened beverage intake, including fruit juice, throughout childhood and adolescence is associated with higher markers of diabetes risk in late adolescents in boys but not girls. It’s striking that many measures of type 2 diabetes risk were increased in boys at such an early age.”

Kris-Etherton, an emeritus professor of nutritional sciences at Penn State University, was also a coauthor of the association’s 2018 science advisory on low-calorie sweetened beverages and cardiometabolic health.

“Importantly, although fruit intake didn’t appear to be protective, it nonetheless wasn’t associated with increased type 2 diabetes risk,” she says. “These findings support the current dietary recommendations of the American Heart Association, and many organizations, to limit or eliminate drinking sugar-sweetened beverages and instead consume whole fruits, which are high in so many nutrients, especially the shortfall nutrients in the average American diet.” (Shortfall nutrients are the vitamins and nutrients that people are missing each day from the foods they eat; long-term deficiencies in some vitamins and nutrients have been linked to adverse health outcomes.)

— Source: American Heart Association

How Home Food Availability Affects Young Children’s Nutrient Intake

Early childhood is an important time for learning about nutrition and establishing healthful eating behaviors. Young children rely on parents to provide food options, and the availability of food in the home affects their dietary choices. A new study from the University of Illinois Urbana-Champaign looks at changes in home food availability and nutrient intake for children from age 2 to 4.

“It's important to understand how the environments that children are in can influence their diet and nutrition. What types of foods and beverages are available in the home, and how accessible are those items for the young child? It’s about the likelihood of exposure to foods and having the opportunity to try foods, and also whether they may be able to access or grab foods themselves,” says lead author Jennifer Barton, PhD, an assistant research professor at Pennsylvania State University. Barton conducted the research as a postdoctoral research associate at the Family Resiliency Center in the department of human development and family studies, part of the College of Agricultural, Consumer and Environmental Sciences at Illinois.

Barton and her colleagues used the Home Food Inventory (HFI) to measure food availability at 24, 36, and 48 months of age. The HFI is a comprehensive checklist of food categories administered by a research assistant visiting the homes of participating families. The researchers correlated the HFI data with surveys of the children’s food consumption completed by their mothers.

“We found significant changes in several food categories over time. Food items such as nonwhole grains, processed meats, savory snacks, candy, and microwavable or quick-cook foods were more commonly available in the home at 48 months compared to 24 and 36 months,” Barton says.

The study included 468 mothers and children who were participants in STRONG Kids 2, an ongoing research project in Illinois that looks at nutrition and healthful habits from infancy through 10 years of age. STRONG Kids 2 codirectors Barbara Fiese, PhD, a professor emerita of human development and family studies, and Sharon Donovan, PhD, RD, a professor of food science and human nutrition at Illinois, also contributed to the study.

The HFI includes an obesogenic score, which indicates the obesity risk of different foods. However, the scores are based on dietary recommendations for older children and include regular-fat dairy products such as milk, yogurt, and cheese. Toddlers have different energy and nutrient needs, and dairy products are considered as part of a healthful diet for young children, necessary for growth and development.

The researchers tested three obesogenic scores, two of which were developmentally sensitive scores that excluded milk, yogurt, and cheese. Even with the modified categories, they found that obesogenic scores increased significantly from 24 to 48 months.

“It makes sense that as children get older, the presence of more energy-dense and high-fat foods tends to grow. Children may request these foods more often, and outside influences, such as the opinions of peers, are starting to become more apparent. I do want to point out that we found some positive changes. Vegetables also become more available in the home at 48 months,” Barton says.

“The point isn’t to label certain foods as being good or bad. We likely all have food items in our homes that aren’t ‘recommended.’ It’s really about trying to make sure that we get enough nutritious, recommended foods and eat the nonrecommended items in moderation.”

A second research goal was to test the validity of the HFI measure for young children, as the method has been developed for adolescents. Barton and her colleagues conducted comprehensive tests of associations between food availability and nutrient intake, overall finding the expected results.

For example, the availability of processed meats such as lunch meat and hot dogs was correlated with higher saturated fat intake. Sweetened beverages, candy, desserts, and savory snacks were correlated with higher intake of those foods. A higher presence of fruit and vegetables in the home was also a consistent indicator of nutrients. These findings indicate that HFI is a reliable measure of home food availability and has demonstrated associations with food and nutrient intake for children aged 24, 36, and 48 months, the researchers conclude.

It’s important to support parents in making healthful decisions for their families, but food choice is much more than individual behavior, Barton states.

“There are complex factors affecting parents’ decisions. Children may ask for certain foods, which may stem from the influence of media and advertising. We should also consider who else lives in the home such as siblings, and the parents may experience work demands and financial stressors that can spill over into their family life. Many people struggle with distance to food stores and access to fresh foods as well as food insecurity. I believe we need a food systems approach to ensure people have access to nutritious food and that parents feel supported in making decisions to promote the health and well-being of themselves and their children,” she concludes.

— Source: University of Illinois College of Agricultural, Consumer, and Environmental Sciences