100% Juice, Fruit, and Vegetable Intake Among Children in the Special Supplemental Nutrition Program for Women, Infants, and Children and Nonparticipants

Abstract

Introduction: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides monthly food packages to low-income children (aged 1-4 years) in the U.S., including 128 ounces of 100% fruit juice and an $8 cash value voucher for purchasing fruits and vegetables. The fruit juice allowance translates to 71%-107% of the maximum intake recommended by the American Academy of Pediatrics (4-6 ounces/day). Careful examination of WIC food package allocations is necessary because overconsumption of fruit juice among young children has been linked to weight gain and juice lacks important nutrients found in whole fruit (e.g., fiber).

Methods: A total of 1,576 children aged 2-4 years were assessed using the 2009-2014 National Health and Nutrition Examination Surveys. Multiple linear regressions were conducted in 2017 to analyze the association between WIC program participation and intake of 100% fruit juice, whole fruits, and vegetables. Logistic regression was used to examine the association between WIC program participation and the odds of exceeding the American Academy of Pediatrics maximum intake for juice.

Results: Adjusting for child and parent/caregiver characteristics, WIC participants consumed significantly more 100% fruit juice (β=0.22 cup equivalents/day, 95% CI=0.04, 0.40) compared with income-eligible nonparticipants, but not more whole fruits or total vegetables. WIC participants had 1.51-times greater odds (95% CI=1.06, 2.14) of exceeding the age-specific American Academy of Pediatrics maximum intake for juice compared with income-eligible nonparticipants.

Conclusions: These findings support recommendations to reduce 100% fruit juice allowances in the WIC program and reallocate those funds to the cash value voucher to increase whole fruit and vegetable consumption.

Figure 1.

Adjusted intakes of total fruit, juice, whole fruit, and vegetables comparing WIC participants with nonparticipants. Note: Error bars indicate the 95% CI of estimate. For total fruit, whole fruit, and total vegetables, the national guideline is the amount recommended in the DGA for a 1,300 calorie diet, which is appropriate for most children aged 2–4 years. For 100% fruit juice, the depicted guideline is the AAP recommendations for the maximum amount for children aged 1–3 years (4 ounces) and the lower bound of the maximum range recommended for children aged 4–6 years (4–6 ounces). Unlike the DGA values for total fruit, whole fruit, and total vegetables, the recommendation for fruit juice should be viewed as a maximum intake recommendation (i.e., a limit rather than a target). Total fruit is the sum of fruit juice and whole fruit. *Indicates statistically significant difference (p<0.05) between nonparticipant group and WIC participants. WIC, Special Supplemental Nutrition Program for Women, Infant and Children; DGA, 2015– 2020 Dietary Guidelines for Americans; AAP, American Academy of Pediatrics.