Pediatric Weight Management

Tami's Folder


Skinner JD, Carruth BR, et al. Fruit juice intake is not related to children's growth. Pediatrics, 1999; 103:58-64.

PubMed ID: 9917440
Study Design:
Cohort Study
B - Click here for explanation of classification scheme.
Quality Rating:
Positive POSITIVE: See Quality Criteria Checklist below.
Research Purpose:
To determine whether excess fruit juice intake is associated with short stature and obesity in preschool children.
Inclusion Criteria:
Not described.
Exclusion Criteria:
Not described.
Description of Study Protocol:
  • Dietary data (three days' data collected during at-home interviews: One 24-hour recall; two days of food records that had been kept before the interview).
  • A registered dietitian reviewed food records with mothers for completeness and accuracy. All mothers received previous instructions on keeping food records.
  • At each interview the child's height (without shoes) was measured with a steel tape to the nearest 0.1 cm using a wall or doorway in the child's home and a square (i.e., two boards attached at a right angle). The child's weight was measured to the nearest 0.1 lb, using a standard scale.
  • Demographic data were collected at the initial interview and updated regularly, as appropriate.

Statistical Analyses

  • Mixed model repeated measures analyses (PROC MIXED) to test for mean differences in child height, child BMI and child PI between two juice consumption groups, adjusting for maternal height, child age, child gender and child age-gender interaction.
Data Collection Summary:
  • Daily beverage consumption including milk, fruit juice, soda pop and other drinks
  • Height (measured)
  • Weight (measured).
Description of Actual Data Sample:
  • Sample: 105
  • Age: 24-36 months
  • Ethnicity: White
  • SES: From middle and upper socioeconomic status families
  • Duration: Three years
  • Location: Tennessee.
Summary of Results:

Fruit Juice and Height

  • No significant association was found between short stature and juice intake level. The correlation between height and juice intake was not statistically significant (P=0.09).

Fruit Juice and Obesity

  • No significant associations found between measures of obesity and daily fruit consumption.
  • Juice intake was not significantly correlated with children’s weight, BMI or PI.
  • There is no evidence that the prevalence of overweight was higher among children consuming excessive amounts of fruit juice (=12 ounces per day).
Author Conclusion:

Fruit Juice Consumption and Growth

  • These data support the position that fruit juice intake (<12 ounces per day vs. =12 ounces per day) does not interfere with children’s linear growth.

Fruit Juice and Obesity

  • Results of this study contradict those from Dennison’s study, which gave rise to media campaigns encouraging mothers to limit children’s juice consumption (which was noted to be associated with measures of obesity in young children).
Funding Source:
Gerber Products Company
Food Company:
University/Hospital: University of Tennessee
Reviewer Comments:
[Note: Only three children in this study consumed 12 ounces per day over time and only one of these had 12 ounces per day at all seven dietary interviews. Convenience sample and inclusion and exclusion criteria not described.]
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) N/A
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) N/A
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? Yes
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? Yes
  2.2. Were criteria applied equally to all study groups? Yes
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? No
  4.1. Were follow-up methods described and the same for all groups? No
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) No
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? No
  4.4. Were reasons for withdrawals similar across groups? ???
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? Yes
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) Yes
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? Yes
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? Yes
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? Yes
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? No
9. Are conclusions supported by results with biases and limitations taken into consideration? No
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? No
10. Is bias due to study's funding or sponsorship unlikely? No
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? No