A Health Professional Educational Tool

Authored by Welch’s Health & Nutrition Advisory Panel

grapescience.com

The Whole Truth About 100% Fruit Juice

100% Fruit Juice: Complementing Whole Fruit in a Healthy Diet

Fruit provides important nutrients for overall health, yet most people fall short of meeting their daily recommended goals of 1-2 cups.1,2 As a complement to whole fruit, 100% fruit juice can be a convenient, delicious and nutritious way to squeeze more fruit into the day. And, 100% fruit juice makes it easier to try a variety of colorful fruit as part of a balanced diet throughout the year. So, your favorite fruit is always “in season” when enjoyed as 100% juice!

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Children 2-3 years4-8 years

1 cup1-1 ½ cups

Girls 9-13 years14-18 years

1 ½ cups1 ½ cups

Boys 9-13 years14-18 years

1 ½ cups2 cups

Women 19-30 years31-50 years51+ years

2 cups1 ½ cups1 ½ cups

Men 19-30 years31-50 years51+ years

2 cups2 cups2 cups

The American Academy of Pediatrics (AAP) and the 2010 Dietary Guidelines for Americans (DGA) agree that, while people should aim to eat whole fruit first, moderate consumption of 100% fruit juice can be part of a healthy diet and can help people meet their daily goals for fruit intake.1,3 100% fruit juice, along with fresh, frozen and canned fruit, counts toward daily fruit servings and provides key nutrients to support a healthy lifestyle.1

Yet, myths persist that 100% fruit juice is a source of “empty calories.” This tool shares the latest science to provide the whole truth behind the role of 100% fruit juice in a healthy diet.

Daily Fruit RecommendationsMyPlate fruit recommendations vary by age, gender and physical activity level. Any fruit or 100% fruit juice counts as part of the Fruit Group.

Key Message: Help people squeeze more fruit into their day: just 4 ounces of 100% juice counts as one serving, or ½ cup, of fruit.

suPPorting the recoMMendations

The following sections expand on the recommenda-tions and review the evidence supporting the health benefits associated with increased emphasis on veg-etables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, and oils. An important underly-ing principle is the need to control calories to manage body weight while making choices to support these food and nutrient recommendations. The best way to do this is to consume foods in nutrient-dense forms.

Nutrient-dense foods provide vitamins, minerals, and other substances that may have positive health effects, with relatively few calories. They are lean or low in solid fats, and minimize or exclude added solid fats, added sugars, and added refined starches, as these add calories but few essential nutrients or dietary fiber. Nutrient-dense foods also minimize or exclude added salt or other compounds high in sodium. Ideally, they are in forms that retain naturally occurring components such as dietary fiber. All vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats and poultry

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, eggs, beans and peas (legumes), and nuts and seeds that are prepared without added solid fats, sugars, starches, and sodium are nutrient-dense.

vegetables and fruits Three reasons support the recommendation for Americans to eat more vegetables and fruits. First, most vegetables and fruits are major contributors of a number of nutrients that are underconsumed in the United States, including folate, magnesium, potassium, dietary fiber, and vitamins A, C, and K.61

Several of these are of public health concern for the general public (e.g., dietary fiber and potassium) or for a specific group (e.g., folic acid for women who are capable of becoming pregnant).

Second, consumption of vegetables and fruits is associated with reduced risk of many chronic diseases. Specifically, moderate evidence indicates

1that intake of at least 2 /2 cups of vegetables and fruits per day is associated with a reduced risk of cardiovascular disease, including heart attack and stroke. Some vegetables and fruits may be protective against certain types of cancer.

Beans and Peas are unique foods

Beans and peas are the mature forms of legumes. They include kidney beans, pinto beans, black beans, garbanzo beans (chickpeas), lima beans, black-eyed peas, split peas, and lentils.

Beans and peas are excellent sources of protein. They also provide other nutrients, such as iron and zinc, similar to seafood, meat, and poultry. They are excellent sources of dietary fiber and nutrients such as potassium and folate, which also are found in other vegetables.

Because of their high nutrient content, beans and peas may be considered both as a vegeta-ble and as a protein food. Individuals can count beans and peas as either a vegetable or a protein food.

Green peas and green (string) beans are not considered to be “Beans and Peas.” Green peas are similar to other starchy vegetables and are grouped with them. Green beans are grouped with other vegetables such as onions, lettuce, celery, and cabbage because their nutrient content is similar to those foods.

deciPhering the Juice in Juice

The percent of juice in a beverage may be found on the package label, such as “contains 25% juice” or “100% fruit juice.” Some labels may say they provide 100% of a nutrient, such as “provides 100% Daily Value for vitamin C.” Unless the package also states it is “100% juice,” it is not 100% juice. Sweetened juice products with minimal juice content, such as juice drinks, are considered sugar-sweetened beverages rather than fruit juice.

61. Food sources of shortfall nutrients that are not of major concern for public health (e.g., magnesium, vitamin A, vitamin C) can be found in Chapter D.2 of the Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 2010, found at www.dietaryguidelines.gov.

DIETARY GUIDELINES FOR AMERICANS, 2010 | Chapter Four 35

products refer to the naturally occurring sugars found in the fruit from which the juice was squeezed.

100% fruit juice contains those natural fruit sugars along with vitamins, minerals and plant nutrients. As the DGA state: “sugars found naturally in foods are part of the food’s total package of nutrients and other healthful components.”1

Key Message: 100% fruit juice provides nutrition squeezed from whole fruit without added sugars.

Dietary Guidelines

for Americans

U.S. Department of Agriculture

U.S. Department of Health and Human Services

www.dietaryguidelines.gov

The 2010 DGA encourage people to limit consumption of foods that contain added sugars, as well as foods containing solid fats and sodium.1

Unlike sugar-sweetened beverages, 100% juice has no added sugar. The grams of sugar listed on the Nutrition Facts panels of 100% fruit juice

Look for no sweeteners or words such as sugar, high fructose corn syrup, honey or other synonyms for sugar.

**CONTAINS NATURAL FRUIT SUGARS ONLYINGREDIENTS: GRAPE JUICE FROM CONCEN-TRATE (FILTERED WATER, GRAPE JUICE CONCENTRATE), GRAPE JUICE, CITRIC ACID (FOR TARTNESS), ASCORBIC ACID (VITAMIN C)

NO ARTIFICIAL FLAVORS, NO PRESERVATIVES, AND NO COLORS ADDED.

Nutrition FactsServing Size: 8 FL. OZ. (240mL)Servings Per Container: 8

Amount Per ServingCalories 140 % Daily Value*Total Fat 0g 0%Sodium 15mg 1%Potassium 140mg 4%Total Carb 38g 13% Sugars 36g**Protein 1gVitamin C 120%Calcium 2%Magnesium 6%Manganese 20%Not a significant source of fat cal, sat fat, trans fat, cholest, fiber, vitamin A, and iron.

*Percent Daily Values are based on a 2,000 calorie diet.

Sugar and 100% Fruit Juice: Separating Fact from Fiction

CONTAINS 100% JUICE

It’s important to remind clients to check the label and look for 100% fruit juice to ensure no sugar has been added and to get the most nutrients in every calorie. Other information to look for on the package is illustrated below.

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Like whole fruit, 100% fruit juice contains important vitamins, minerals and plant nutrients, such as polyphenols. And, in some cases, drinking 100% fruit juice may actually provide more of these beneficial polyphenols than eating the fruit. For example, the same polyphenols in Concord grapes are found in 100% grape juice – but the polyphenols in whole Concord grapes are found in the grape’s thick skin as well as its seeds, both of which are generally discarded and left uneaten.

To make 100% grape juice, Concord grapes are crushed – skin, seeds and all – and heated

100% Fruit Juice: Delivering Benefits of Whole Fruit

to release plant nutrients straight from the grape into the juice. So, drinking 100% grape juice made with Concord grapes makes it easier to enjoy the benefits of these plant nutrients.

The implication is not that 100% fruit juice should be consumed exclusively, but rather that both whole fruit and 100% juice contribute to a healthy lifestyle. While eating whole fruit provides fiber – a nutrient lacking in many Americans’ diets – there are benefits to enjoying both whole fruit and 100% juice in a balanced diet to get the most nutrient benefits from fruit.

Key Message: To enjoy all the benefits fruit offers, consume whole fruit and moderate amounts of 100% fruit juice as part of a healthy diet. 100% juice delivers convenient, concentrated nutrients including polyphenols, while whole fruit can be a better source of fiber.

The same polyphenols in Concord grapes are found in 100% grape juice – but the polyphenols are found in the grape’s skin as well as its seeds, which are generally discarded and uneaten.

Polyphenols and Health: Juicy New Research Emerging research is now underway to understand the effect of polyphenols on glucose absorption and carbohydrate metabolism. A review by Haniheva et al explored the effect of certain polyphenols (flavonoids) on carbohydrate metabolism and glucose absorption and found that polyphenols may limit the rate of sugar absorption in the gut.4 This could mean experiencing less of a “sugar spike” and more sustained energy after consuming certain 100% fruit juices rich in flavonoids versus other sugar-containing beverages. However, science in this area is very preliminary, and more research is needed to understand the impact of 100% fruit juice consumption on carbohydrate digestion, absorption and metabolism in humans.

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100% Fruit Juice: A Nutrient-Dense Beverage

Key Message: Sip your way to essential nutrients. For every calorie, 100% juice packs more nutrition than many other beverage options.

Consuming a variety of fruits and vegetables is a recognized way to maximize the intake of vitamins, minerals and beneficial plant nutrients. 100% fruit juices are key sources of these essential nutrients, and a growing body of evidence suggests certain juices may be linked to specific health benefits. In fact, more than a decade’s worth of research suggests that, thanks to the Concord grape, 100% grape juice can help support a healthy heart.5-16

Studies also show the consumption of 100% fruit juice is closely linked to better nutrient intake among children, particularly certain “nutrients of concern” as identified in the 2010 DGA.17-20 In one study of intake among children 2-18 years of age, 100% fruit juice consumption is associated with higher intakes of vitamins A and C, magnesium, folate, phosphorus, and potassium.17

While 100% fruit juice typically does not contain as much fiber as whole fruit, research suggests drinking 100% fruit juice does not negatively impact dietary fiber intake. An analysis of the 2003-2006 National Health and Nutrition Examination Survey (NHANES) showed that fiber intake among 100% fruit juice drinkers was not lower than non-juice drinkers.17

More than a decade’s worth of research suggests that, thanks to the Concord grape, 100% grape juice can help support a healthy heart.5-16

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100% Fruit Juice and Healthy Weight

Key Message: No single food or beverage is responsible for the obesity epidemic. People should feel good about drinking 100% fruit juice in moderation, as the weight of the evidence shows that 100% fruit juice is not associated with over-weight or obesity in healthy adults and children.

The Weight of the ResearchYou might be aware of increased attention on possible negative aspects of 100% juice. The evidence behind such concerns is scant; in fact, the majority of the scientific evidence suggests that moderate 100% fruit juice consumption is not associated with overweight or obesity in healthy adults and children.19-41 In one analysis of NHANES (1999-2002), children and adults who consumed 100% grape juice versus those who did not:21

• Showed no differences in total energy (calorie) intake, weight, body mass index (BMI) or waist circumference

• Consumed more servings of fruit, and children had lower intakes of added sugar

• Had higher intakes of vitamin C and potassium

While a handful of studies has noted possible associations between juice consumption and overweight and obesity,42-49 there are challenges with interpreting the data and applying the results for public health. For example, some of the studies did not distinguish between 100% juice and other fruit drinks, or were done with a smaller, more regional scope.

Filling Facts on 100% JuiceThe role of foods and beverages on satiety and their impact on weight management is an area of evolving research. While some research indicates beverages have less of an impact on satiety than eating solid foods,50-53 other data suggest that, as with solid foods, the satiety response is dependent on a number of factors such as the volume consumed, the proximity to other foods consumed and the composition of the beverage.54-62

One study by Hollis, Mattes and colleagues found that consuming a polyphenol-free, grape-flavored, sugar-sweetened beverage resulted in a reported reduction in fullness, as well as moderate but significant weight gain, whereas drinking Concord grape juice was not associated with significant changes in appetite, weight or increased energy intake. In fact, in this research, drinking Concord grape juice was associated with reduced waist circumference.62

While intake of nutrient-dense foods is an important part of a healthy diet, one mustn’t forget the critical need to balance calories. No matter how healthy the food, when energy (calorie) intake exceeds energy expenditure, the result is weight gain.

“The overwhelming volume of scientific evidence suggests that there is no systematic association between consumption of 100% fruit juice and obesity using a variety of study populations and a variety of measures of adiposity.” Carol E. O’Neil, PhD, MPH, RD, LDN

While intake of nutrient- dense foods is an important part of a healthy diet, one mustn’t forget the critical need to balance calories. No matter how healthy the food, when energy (calorie) intake exceeds energy expenditure, the result is weight gain.

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Registered dietitians and other health professionals recognize the value of 100% fruit juice as part of an overall healthy diet. As the 2010 Dietary Guidelines Advisory Committee stated: “When consumed in moderation as part of a nutrient-rich, energy-balanced diet, 100% juice can be a healthy part of a child’s diet.”63

According to a national survey of registered dietitians, 100% fruit juice is among the top beverages they would recommend to their clients (adults and children), in addition to water, milk and vegetable juice,64 yet only 60% of Americans consume 100% fruit juice at least once in an average two-week period.65

“Drinking 100% fruit juice is an effective, convenient and delicious way to increase fruit intake. It also gives a nutrition and flavor boost to recipes, such as spritzers, salad dressings and even entrees.” Wendy Jo Peterson, MS, RD, CSSD

100% Fruit Juice in a Healthy Diet: Voices from Leading Health Experts

“Enjoying a healthy lifestyle means balancing a variety of options. When whole fruit isn’t readily available or desired, 100% fruit juice is a conve-nient, delicious and nutritious way to get more fruit. And, whether you’re choosing whole fruit or fruit juice, serving size matters.” Robyn Flipse, MS, MA, RDN

Ages 0-6 months avoid 100% juice

Ages 1-6 years limit to 4-6 ounces

Ages 7-12 years up to 12 ounces

American Academy of Pediatrics Daily Recommendations for 100% JuiceAAP states that moderate consumption of 100% fruit juice can be part of a healthy diet and can help people meet their daily goals for fruit intake.3

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References:1. U.S. Department of Agriculture and U.S. Department

of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, December 2010.

2. Krebs Smith SM, Guenther PM, Subar AF, Kirkpatrick SI and Dodd KW. Americans do not meet federal di-etary recommendations. J Nutr. 2010. 140(10):1832-1838.

3. American Academy of Pediatrics (AAP). Committee on Nutrition. The use and misuse of fruit juice in pediatrics. Pediatrics. 2001. 107:1210-1213.

4. Hanhineva K, Törrönen R, Bondia-Pons I, Pekkinen J, Kolehmainen M, Mykkänen H and Poutanen K. Impact of Dietary Polyphenols on Carbohydrate Metabolism. Int. J. Mol. Sci. 2010. 11(4):1365-1402.

5. Albers AR, Varghese S, Vitseva O, Vita JA and Freedman JE. The antiinflammatory effects of pur-ple grape juice consumption in subjects with stable coronary artery disease. Arterioscler Thromb Vasc Biol. 2004. 24(11):e179-180.

6. Anselm E, Chataigneau M, Ndiaye M, Chataigneau T and Schini-Kerth VB. Grape juice causes endotheli-um-dependent relaxation via a redox-sensitive Src- and Akt-dependent activation of eNOS. Cardiovasc Res. 2007. 73(2):404-413.

7. Chou EJ, Keevil JG, Aeschlimann S, Wiebe DA, Folts JD and Stein JH. Effect of ingestion of purple grape juice on endothelial function in patients with coronary heart disease. Am J Cardiol. 2001. 88(5):553-555.

8. Fitzpatrick DF, Hirschfield SL and Coffey RG. En-dothelium-dependent vasorelaxing activity of wine and other grape products. Am J Physiol Heart Circ Physiol. 1993. 265(2):H774-H778.

9. Freedman JE, Parker C, 3rd, Li L, Perlman JA, Frei B, Ivanov V, Deak LR, Iafrati MD and Folts JD. Select flavonoids and whole juice from purple grapes inhibit platelet function and enhance nitric oxide release. Circulation. 2001. 103(23):2792-2798.

10. Keevil JG, Osman HE, Reed JD and Folts JD. Grape juice, but not orange juice or grapefruit juice, inhibits human platelet aggregation. J Nutr. 2000. 130(1):53-56.

11. O’Byrne DJ, Devaraj S, Grundy SM and Jialal I. Comparison of the antioxidant effects of Concord grape juice flavonoids alpha-tocopherol on markers of oxidative stress in healthy adults. Am J Clin Nutr. 2002. 76(6):1367-1374.

12. Stein JH, Keevil JG, Wiebe DA, Aeschlimann S and Folts JD. Purple grape juice improves endothelial function and reduces the susceptibility of LDL cho-lesterol to oxidation in patients with coronary artery disease. Circulation. 1999. 100(10):1050-1055.

13. Vinson JA, Yang J, Proch J and Liang X. Grape juice, but not orange juice, has in vitro, ex vivo, and in vivo antioxidant properties. J Med Food. 2000. 3(4):167-171.

14. Vislocky LM and Fernandez ML. Biomedical Effects of Grape Products. Nutr Rev. 2010. 68(11):656-670.

15. Vislocky LM and Fernandez ML. Grapes and Grape Products: Their Role in Health. Nutr Today. 2013. 48(1):47-51.

16. Park YK, Kim J-S and Kang M-H. Concord grape juice supplementation reduces blood pressure in Korean hypertensive men: double-blind, placebo controlled intervention trial. Biofactors. 2004. 22(1-4):145-147.

17. O’Neil CE, Nicklas TA, Zanovec M, Kleinman RE and Fulgoni, III VL. Fruit juice consumption is associated with improved nutrient adequacy in children and adolescents: the National Health and Nutrition Examination Survey (NHANES) 2003–2006. Public Health Nutrition. 2012. 15(10):1871-1878.

18. Fox MK, Reidy K, Novak T and Ziegler P. Sources of energy and nutrients in the diets of infants and toddlers. J Am Diet Assoc. 2006. 106:S28-S42.

19. Nicklas TA and O’Neil CE. Association between 100% juice consumption and nutrient intake and weight of children aged 2 to 11 years. Arch Pediatr Adolesc Med. 2008. 162:557-565.

20. O’Neil CE, Nicklas TA, Rampersaud GC and Fulgoni III VL. 100% Orange juice consumption is associ-ated with better diet quality, improved nutrient adequacy, decreased risk for obesity, and improved biomarkers of health in adults: National Health and Nutrition Examination Survey, 2003-2006. Nutrition Journal. 2012. 11:107.

21. McGill CR, Wightman JD, Fulgoni S and Fulgoni III VL. Consumption of purple/blue produce is asso-ciated with increased nutrient intake and reduced risk for metabolic syndrome: results from the National Health and Nutrition Examination Survey 1999-2002. Am J Lifestyle Med. May/June 2011. 5(3):279-290.

22. Skinner JD and Carruth BR. A longitudinal study of children’s juice intake and growth: the juice contro-versy revisited. J Am Diet Assoc. 2001. 101:432-437.

23. O’Connor TM, Yang SJ and Nicklas TA. Beverage intake among preschool children and its effect on weight status. Pediatrics. 2006. 118:e1010-e1018.

24. Field AE, Gillman MW, Rosner B, Rockett HR and Colditz GA. Association between fruit and vegeta-ble intake and change in body mass index among a large sample of children and adolescents in the United States. Int J Obes Relat Metab Disord. 2003. 27:821-826.

25. O’Neil CE and Nicklas TA. A review of the relation-ship between 100% fruit juice consumption and weight in children and adolescents. Am J Lifestyle Med. 2008. 2:315-354.

26. Forshee RA and Storey ML. Total beverage con-sumption and beverage choices among children and adolescents. Int J Food Sci Nutr. 2003. 54:297-307;

27. LaRowe TL, Moeller SM and Adams A. Beverage patterns, diet quality, and body mass index of US preschool and school-aged children. J Am Diet Assoc. 2007. 107:1124-1133;

28. O’Neil CE, Nicklas TA and Kleinman R. Relationship between 100% juice consumption and nutrient intake and weight of adolescents. Am J Health Promot. 2010. 24:231-7.

29. Nicklas TA, O’Neil CE and Kleinman R. Association between 100% juice consumption and nutrient intake and weight of children 2 to 11 Years. Arch Pediatr Adolesc Med. 2008. 162:557-565.

30. Kloeblen-Tarver AS. Fruit juice consumption not related to growth among pre-school aged children enrolled in the WIC program. J Am Diet Assoc. 2001. 101:996.

31. Beck AL, Tschann J, Butte NF, Penilla C and Green-span LC. Association of beverage consumption with obesity in Mexican American children. Public Health Nutr. 2013 Jan 11:1-7. [Epub ahead of print].

32. Alexy U, Sichert-Hellert W, Kersting M, Manz F and Schöch G. Fruit juice consumption and the prevalence of obesity and short stature in German preschool children: results of the DONALD Study. Dortmund Nutritional and Anthropometrical Lon-gitudinally Designed. J Pediatr Gastroenterol Nutr. 1999. 29:343-349.

33. Nelson JA, Carpenter K and Chiasson MA. Diet, activity, and overweight among pre- school-age children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Prev Chronic Dis. 2006. 3:A49.

34. Skinner JD, Carruth BR, Moran J III, Houck K, and Coletta F. Fruit juice intake is not related to chil-dren’s growth. Pediatrics. 1999. 103:58-64.

35. Striegel-Moore RH, Thompson D, Affenito SG, Franko DL, Obarzanek E, Barton BA, Schreiber GB, Daniels SR, Schmidt M and Crawford PB. Correlates of beverage intake in adolescent girls: the National Heart, Lung, and Blood Institute Growth and Health Study. J Pediatr. 2006. 148(2):183-187.

36. Johnson L, Mander AP, Jones LR, Emmett PM and Jebb SA. Is sugar-sweetened beverage consump-tion associated with increased fatness in children? Nutrition. 2007. 23:557-563.

37. Blum JW, Jacobsen DJ and Donnelly JE. Beverage consumption patterns in elementary school aged children across a two-year period. J Am Coll Nutr. 2005. 24:93-98.

38. Berkey CS, Rockett HRH, Field AE, Gillman MW and Colditz GA. Sugar-added beverages and adolescent weight change. Obes Res. 2004. 12:778-788.

39. Newby PK, Peterson KE, Berkey CS, Leppert J, Willett WC and Colditz GA. Beverage consumption is not associated with changes in weight and body mass index among low-income preschool children in North Dakota. J Am Diet Assoc. 2004. 104:1086-1094.

40. Vanselow MS, Pereira MA, Neumark-Sztainer D, Raatz SK. Adolescent beverage habits and changes in weight over time: findings from Project EAT. Am J Clin Nutr. 2009. 90(6):1489-1495.

41. Wang Y, Lloyd B, Yang M, Davis CG, Lee SG, Lee W, Chung SJ and Chun OK. Impact of orange juice consumption on macronutrient and energy intakes and body composition in the US population. Public Health Nutrition. 2012. 15:2220-2227.

42. Mozaffarian D, Hao T, Rimm EB, Willett WC and Hu F. Changes in diet and lifestyle and long-term weight gain in women and men. NEJM. 2011. 364:2392-2404.

43. Faith MS, Dennison BA, Edmunds LS, Stratton HH. Fruit juice intake predicts increased adiposity gain in children from low-income families: weight status-by environment interaction. Pediatrics. 2006. 118(5):2066-75.

44. Dennison BA, Rockwell HL and Baker SL. Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity. Pediat-rics.1997. 99:15-22.

45. Dennison BA, Rockwell HL, Nichols MJ and Jenkins P. Children’s growth parameters vary by type of fruit juice consumed. J Am Coll Nutr. 1999. 18:346-352.

46. Libuda L, Alexy U, Sichert-Hellert W, Stehle P, Karaolis-Danckert N, Buyken AE and Kersting M. Pattern of beverage consumption and long-term associations with body-weight status in German adolescents: results from the DONALD study. Br J Nutr. 2008. 99(6):1370-9.

47. Sanigorski AM, Bell AC and Swinburn BA. Associ-ation of key foods and beverages with obesity in Australian schoolchildren. Public Health Nutrition. 2007. 10(2):152-157.

48. Welsh JA, Cogswell ME, Rogers S, Rockett H, Mei Z and Grummer-Strawn LM. Overweight among low-income preschool children associated with the consumption of sweet drinks: Missouri, 1999-2002. Pediatrics. 2005. 115(2):e223-9.

49. Melgar-Quinonez HR and Kaiser LL. Relationship of child-feeding practices to overweight in low-income Mexican-American preschool-aged children. J Am Diet Assoc. 2004. 104:1110-1119.

50. Pan A and Hu FB. Effects of carbohydrates on sati-ety: differences between liquid and solid food. Curr Opin Clin Nutr Metab Care. 2011. 14(4):385-90.

51. Flood-Obbagy JE and Rolls BJ. The effect of fruit in different forms on energy intake and satiety at a meal. Appetite. 2009. 52(2):416-22.

52. Mattes RD and Campbell WW. Effects of food form and timing of ingestion on appetite and energy intake in lean young adults and in young adults with obesity. J Am Diet Assoc. 2009. 109(3):430-7.

53. Mourao DM, Bressan J, Campbell WW and Mattes RD. Effects of food form on appetite and energy intake in lean and obese young adults. Int J Obes (Lond). 2007. 31(11):1688-95.

54. DiMeglio DP and Mattes RD. Liquid versus solid car-bohydrate: effects on food intake and body weight. Int J Obes. 2000. 24:794-800.

55. Almiron-Roig E, Flores SY and Drewnowski A. No difference in satiety or in subsequent energy intakes between a beverage and a solid food. Physiol Behav. 2004. 82:671-677.

56. Almiron-Roig E, Chen Y and Drewnowski A. Liquid calories and the failure of satiety: how good is the evidence? Obes Rev. 2003. 4:201-212.

57. Kissileff HR, Gruss LP, Thornton J and Jordan HA. The satiating efficiency of foods. Physiol Behav. 1984. 32:319-332.

58. Rolls BJ, Fedoroff IC, Guthrie JF and Laster LJ. Foods with different satiating effects in humans. Appetite. 1990. 15:115-126.

59. Rolls JB, Barnett RA. Volumetrics Weight-Control Plan. 1st ed. New York, NY: HarperCollins Publishers (Quill edition). 2000. 21.

60. Almiron-Roig E and Drewnowski A. Hunger, thirst, and energy intakes following consumption of caloric beverages. Physiol Behav. 2003. 79:767-773.

61. DellaValle DM, Roe LS and Rolls BJ. Does the consumption of caloric and non-caloric beverages with a meal affect energy intake? Appetite. 2005. 44:187-193.

62. Hollis JH, Houchins JA, Blumberg JB and Mattes RD. Effects of concord grape juice on appetite, diet, body weight, lipid profile, and antioxidant status of adults. J Am Coll Nutr. 2009. 28(5):574-582

63. Report of the Dietary Guidelines Advisory Commit-tee on the Dietary Guidelines for Americans 2010; Part E. Appendices; Appendix E-1: Major Conclu-sions. May 2010. p 406.

64. WebMD Survey of 310 actively practicing registered dietitians, fielded September-October 2012.

65. The NPD Group, National Eating Trends Report, 2012.

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