Fruit juice can feel like one of the safer choices in the drink aisle. It comes from fruit, it may contain vitamins and it’s often marketed as a better option than soda.
But a new long-term study suggests the picture may be more complicated, especially when juice becomes a regular habit over many years. The study, published in Circulation, followed more than 25,000 people from childhood or adolescence into adulthood and found that higher intake of sugary drinks and fruit juice was associated with a higher risk of developing high blood pressure later in life.
The findings do not prove that juice or sugary drinks caused high blood pressure. The study was observational, meaning it can show patterns but cannot fully separate beverage habits from all the other factors that shape long-term health. Participants also reported their own diets and high blood pressure diagnoses, which can introduce error. Still, the results add to a larger body of research suggesting that what children drink regularly may matter for heart health years later.
“Dietary habits in early life can have lasting health consequences,” said senior study author Vasanti Malik, an associate professor and Canada Research Chair in Nutrition and Chronic Disease Prevention in the department of nutritional sciences at Temerty Faculty of Medicine at the University of Toronto and an adjunct faculty member in the department of nutrition at the Harvard T.H. Chan School of Public Health.
Researchers analyzed data from the Growing Up Today Study, which began in 1996 and 2004 with children of participants in the Nurses’ Health Study II. The analysis included 25,749 participants ages 9 to 16 at the start of the study. About 55% were female and 96% were non-Hispanic white. Participants were followed for up to 25 years, with a median age of 36 by the end of follow-up.
Throughout the study, participants completed food frequency questionnaires about how often they consumed sugar-sweetened beverages, fruit juice and whole fruits. Sugar-sweetened beverages included sodas, fruit punches, lemonades, iced teas, sports drinks and non-carbonated fruit drinks. Fruit juice included orange juice, apple juice and other 100% fruit juices.
The researchers also looked at whether replacing one daily serving of a sugary drink or fruit juice with whole fruit, milk or water was associated with a different risk of high blood pressure.
People who drank two or more servings of sugar-sweetened beverages per day had a 52% higher risk of later developing high blood pressure compared with those who drank less than three servings per week. A serving was defined as a 12-ounce can or glass.
Among sugary drink types, each daily serving of soda was associated with a 23% higher risk of high blood pressure, while each daily serving of sports drinks was associated with a 36% higher risk.
Fruit juice also showed a link at higher levels of intake. People who drank 1.5 or more servings of fruit juice per day had a 35% higher risk of developing high blood pressure compared with those who drank less than one serving per week. A juice serving was defined as an 8-ounce glass.
For specific juices, each daily serving of orange juice was associated with a 20% higher risk of high blood pressure, while apple juice and other juices were not significantly linked. The researchers cautioned that this result should be interpreted carefully because some orange-flavored drinks with added sugars may have been reported as orange juice.
The substitution analysis may be the most useful part for everyday choices. Replacing one daily serving of a sugary beverage with whole fruit was associated with a 22% lower risk of developing high blood pressure. Replacing fruit juice with whole fruit was associated with a 19% lower risk.
Replacing sugary beverages with milk or water was associated with up to a 13% lower risk of high blood pressure. Replacing fruit juice with milk or water was not significantly associated with lower risk.
That does not mean whole fruit is magic or that fruit juice is dangerous in small amounts. It does suggest that the form of fruit may matter. Whole fruit contains fiber and takes more time to eat, while juice can deliver sugar in a much more concentrated form and is easier to drink quickly.
“Sugar-sweetened beverages, such as soda and sports drinks, which are often marketed as somewhat healthy, should be limited,” Malik said. “Fruit juice intake may be harmless at low levels yet harmful at higher intake levels. They should always be 100% fruit juice, and even so, consumed only in moderation. Whole fruit should be emphasized over sugary beverages.”
Amit Khera, an American Heart Association volunteer expert who was not an author of the study, said the findings also challenge a common misunderstanding about fructose, the natural sugar found in fruit.
“Secondly, there has been a misconception about fructose in general being harmful for cardiovascular health regardless of the source, and that fruit juices are beneficial for health. This study demonstrates that neither seems to be correct,” said Khera, director of preventive cardiology and clinical chief of cardiology at the University of Texas Southwestern Medical Center in Dallas.
The study has several important limits. Because most participants were non-Hispanic white and came from families connected to the Nurses’ Health Study II, the findings may not apply equally to the broader U.S. population. Blood pressure diagnoses were self-reported rather than measured directly by researchers. Dietary questionnaires can also miss details, especially when similar drinks are easy to confuse.
The study also cannot determine whether changing a child’s drink habits will directly prevent high blood pressure later. But it does point to a practical pattern: For everyday drinking, whole fruit appears to be a better routine choice than fruit juice, and water or milk may be better regular choices than soda, sports drinks or other sugary beverages.
This study was supported by a grant from the National Institutes of Health. Dr. Nguyen also received support from the Ontario Graduate Scholarship, Peterborough KM Hunter Charitable Foundation Graduate Award, Dalton Whitebread Scholarship Fund, SMART Healthy Cities Trainee Award and Nora Martin Fellowship in Nutritional Sciences. Several authors reported outside funding, consulting, honoraria, travel support or other relationships with nutrition, food, beverage, health and research organizations. These included, among others, organizations connected to fruit juice, dairy, sweeteners, soy, pulses, nuts and other food sectors.