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Fruit juice and the Health Star Rating

After a year and a half of debate, the decision about how to rate pure unsweetened fruit and vegetable juices has been made.

The back story

The last year and a half have seen much debate around fruit juices and how they should score under the Health Star Rating (HSR) system. Issues emerged after the Five-Year Review of the HSR in 2019, and the changes that were made to the HSR calculator that included more strongly penalising total sugars content. Currently, pure juices score between 2.5 and 4 in the revised review calculator depending on natural sugars content. In some cases, diet soft drink scores higher than fruit juice even though the HSR calculator was tweaked to ensure diet soft drinks could score no more than 3.5.

The political angle

Australian Agriculture Minister David Littleproud has been recommending that all pure fruit juices be classified as ‘minimally processed fruit and vegetables’ and therefore score a HSR of 5. When that was rejected, he agreed to a compromise of HSR 4.

The final decision

The Australia and New Zealand Forum on Food Regulation decided on February 12 to reject his recommendation and maintain the status quo. This means pure unsweetened juices will be rated on their total sugars content and can have a HSR lower than diet soft drinks. This decision has upset Australia’s citrus growers, who say it ignores the nutritional value of fruit and vegetable juices. Nutrition Australia says fruit juices should not have as high a HSR as fresh fruit, but it they should score higher than soft drink because of their nutritional value such as vitamin C content.

Are there health risks with fruit and vegetable juices?

Health advocates have suggested pure juices should have lower HSRs because juices contain too much (natural) sugar. They cite obesity concerns, dental risk, and the “toxicity” of fructose as reasons for this. Evidence for these claims is unconvincing.

Obesity. Pure (100%) juice is a minor contributor of energy and sugar. A reanalysis of the Australian Health Survey 2011-13 data conducted by the CSIRO on behalf of the Australian Beverage Council found fruit juice contributed on average less than 1% of total daily energy for Australians overall, and 1.2% in children. When examining fruit juice consumers specifically, juice contributed approximately 5% of total energy intake. In Australians overall fruit juice contributed on average 3.5% of total sugar intake (4.6% among children).

Dental risk. Read our feature in this issue that includes a Systematic Review of 100% fruit juices and dental health that finds no conclusive evidence for a link with dental decay or erosion.

Adverse effects of fructose.  The highest level of evidence from systematic reviews and meta-analyses of controlled trials has not shown fructose-containing sugars behave any differently than other digestible carbohydrates. A review of the health impact of fruit juices  found the evidence unclear and concluded it is impossible to provide evidence-based recommendations as to whether fruit juices have adverse metabolic consequences. A UK prospective cohort study of just under two hundred thousand participants found no adverse association between fruit or vegetable juice intake and mortality.