ATLANTA — Higher consumption of sugary beverages, including fruit juice, was associated with increased mortality in a study appearing online May 17 in JAMA Network Open.

In the study involving 13,440 adults age 45 and older, each additional 12-oz serving per day of sugary beverages was associated with an 11% higher all-cause mortality risk. Each additional 12-oz serving per day of fruit juice was associated with a 24% higher all-cause mortality risk. Similar associations were not found between sugary beverage consumption and coronary heart disease mortality. The study identified sugary beverages as soft drinks, fruit-flavored drinks and 100% fruit juices.

“The nutrient content of 100% fruit juices and SSBs (sugar-sweetened beverages) is very similar,” the study said. “While 100% fruit juices contain some vitamins and phytonutrients that are missing from most SSBs, the predominant ingredients in both are sugar and water.

“Although the sugar in SSBs is added during processing and the sugar in 100% fruit juice occurs naturally, the specific sugars they provide for the body to process are essentially the same, and the biochemical response when metabolized is the same. The sugars contained in all sugary beverages are primarily the monosaccharides glucose and fructose or the disaccharide sucrose, which is quickly broken down with digestion and metabolized into equal parts fructose and glucose.”

The study may be found here. Corresponding author was Jean A. Welsh, Ph.D., from the Department of Pediatrics at Emory University in Atlanta. The National Institute of Neurological Disorders and Stroke, the National Institutes of Health, and the National Heart, Lung, and Blood Institute all provided support for the study.

The Florida Department of Citrus, Barstow, Fla., pointed to several limitations in the study:

• A lack of cause and effect;
• Findings limited to a group made up of mostly white, obese or overweight males age 45 and older;
• A focus on 12-oz increments that do not align with the serving size of 8 oz that consumers see on 100% fruit juice labels; and
• Dietary data were collected only once. Changes in diet and beverage intake over time was not accounted for, nor was family health history or other lifestyle attributes.

“At a time when many Americans are underconsuming fruits and vegetables, studies such as this are a cause for concern,” the Florida Department of Citrus said. “Suggesting that a higher consumption of 100% fruit juice is associated with an increase in all causes of mortality without acknowledging the limitations of the study leads to confusion and conflicting messages for consumers.”

The Florida Department of Citrus said orange juice provides a number of vitamins and minerals.

“The majority of research shows that there is no association between the consumption of 100% orange juice (100% fruit juice) and overweight or obesity status, B.M.I. (body mass index), body fat percentage or waist circumference in children or adults,” the department said. “Additionally, studies show that the consumption of 100% orange juice is not associated with the adverse effects often seen with the overconsumption of added sugars, such as increased risk for metabolic syndrome, insulin resistance, and elevated glucose and insulin levels.”

Data in the study were taken from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study in which enrollment took place from February 2003 to October 2007 with follow-ups every six months through 2013. The people were observed for a mean of six years. While the REGARDS study involved 30,183 non-Hispanic and white adults age 45 and over, the researchers ruled out people with known coronary heart disease, stroke or diabetes at baseline as well as those lacking dietary data, which left 13,440 adults.

The researchers divided people into groups based on sugar intake as a percentage of total energy: low being less than 5%, medium being 5% to up to 10%, and high being 10% or more. Risk-adjusted all-cause mortality hazard ratios were 1.11 for each additional 12 oz of sugary beverage consumed and 1.24 for each additional 12 oz of fruit juice consumed.