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Diabetes and Florida Orange Juice

Metabolic Syndrome

Metabolic syndrome is a group of risk factors that can increase the risk of heart disease, diabetes, and other health problems. These risk factors include abdominal obesity, unhealthy triglyceride and cholesterol levels, high blood glucose, and high blood pressure. Regular exercise and a diet containing nutrient-rich foods are important factors to staying healthy. 100% orange juice is not only a nutrient-rich food, 100% orange juice1 (as well as 100 percent fruit juice)2 is not associated with metabolic syndrome.

Diabetes

Over time the conditions of metabolic syndrome may result in diabetes – a disease resulting from the body’s inability to produce or use insulin. Numerous studies have shown no association between citrus juice or fruit juice intake and diabetes-related outcomes:

  • Combining 12 randomized controlled trials, a meta-analysis concluded that fruit juice intake had no significant effect on fasting glucose and insulin in adults.3
  • A meta-analysis of four prospective cohort studies concluded that the intake of 100 percent fruit juice was not associated with the risk of developing type 2 diabetes in adults.4
  • No association was found between consumption of fruit juice and diabetes risk in U.S. women5, French women6, U.S. men7, Finnish men8, Japanese adults9, U.K. adults10, and European adults.11
  • A large study in post-menopausal women (WHI) found no association between 100 percent citrus juice intake and diabetes risk, even at high levels of consumption; also,100 percent fruit juice intake was not related to diabetes risk.12
  • Intake of 100% orange or grapefruit juice was not related to diabetes incidence in African-American women,13 a group at higher risk for type 2 diabetes.14
  • Higher fruit juice intake by women prior to pregnancy was not related to increased risk of gestational diabetes.15
  • Orange juice consumption in children was not associated with fasting glucose, insulin or measures of adiposity and weight.16
  • Higher fruit juice consumption was not associated with increased risk of developing auto-antibodies to insulin or type 1 diabetes in children.17
  • Fruit juice consumption was not associated with fasting glucose or insulin, and/or HOMA-IR in two separate studies in adults.2,18
  • A systematic review of randomized controlled trials found that 100% fruit juice has no effect on fasting blood glucose or insulin, insulin sensitivity (HOMA-IR), or hemoglobin A1C.29
  • A meta-analysis found there is no evidence that 100% fruit juice has adverse effects on fasting glucose or insulin and is no different than water on these variables; consumption of 100% juice did not increase the risk of diabetes.30

Orange Juice and Blood Glucose Levels

In recent years, studies around 100% orange juice and blood glucose levels have demonstrated a decreased fasting glucose (in men) following consumption,19 or no effect on blood glucose or insulin.20,21,31 A recent study in overweight and obese adults at risk for diabetes showed that 100% orange juice was not different than water on blood glucose or insulin responses when consumed with a meal, even though the orange juice group consumed higher total carbohydrates.32 Even adults drinking high amounts of 100% orange juice (20 to 25 ounces daily) beyond what is recommended for two to three months had no changes in markers of glucose metabolism.22,23 Furthermore, in a cross-over intervention study, consumption of soda resulted in a higher daylong glycemia, higher blood glucose variability, and lower insulin secretion compared to 100% orange juice even though the beverages were matched for sugar content. This study suggests glucose metabolism is different with added-sugar beverages than with 100% orange juice.33

Orange Juice Compared to Other Beverages

Additionally, 100% orange juice may have a distinct advantage over sugary beverages. For example, two independent clinical studies comparing 100% orange juice to a glucose drink or water consumed alongside a high-fat/high carbohydrate meal noted more gradual rises in blood glucose and insulin with orange juice when compared to sugary water.24-25

Orange Juice and Insulin Sensitivity

100% orange juice has also been shown to have no adverse effect on insulin sensitivity in clinical studies with various participants who were at higher risk of diabetes:

  • Overweight men with elevated cholesterol consuming 250mL (~8oz) of 100% orange juice daily for 12 weeks demonstrated no adverse effects on measures of insulin sensitivity, body composition, or other indices of metabolic syndrome.26
  • Obese adults on a reduced-calorie diet and consuming 500 mL of orange juice daily for three months had HOMA-IR(insulin sensitivity), blood glucose, insulin, and blood lipids either improve or stay within healthy ranges while not hindering weight loss.27
  • Obese children consuming 250 mL of mandarin juice twice a day for four weeks supplementing a hypo caloric diet demonstrated decreased insulin levels and HOMA-IR, which was not observed in the control group.28

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*Values based on a 2000 calorie diet. FDA rounding rules applied when calculating percent DV based upon 2018 rules. Information is not intended for labeling food in packaged form. USDA SR28 database entries for 90206 and 09209 were used for calculating RDI.


References

  1. O’Neil et al.Nutr J. 2012;12(11):107.
  2. Duffey et al.Am J Clin Nutr. 2010;92(4):954-959.
  3. Wang et al.PLoS ONE. 2014;9:e95323.
  4. Xi et al. PLoS ONE. 2014;9:e93471.
  5. Schulze et al.JAMA. 2004;292(8):927-934.
  6. Fagherazzi et al. Am J Clin Nutr. 2013;97(3):517-23.
  7. de Koning et al. Am J Clin Nutr 2011;93:1321–1327.
  8. Mursu et al.Am J Clin Nutr. 2014;99(2):328-33.
  9. Eshak et al. Clin Nutr. 2013;32(2):300-308.
  10. O’Connor et al.Diabetologia. 2015;658:1474-1483.471.
  11. The InterAct Consortium. Diabetologia. 2013;56(7):1520-30.
  12. Auerbach et al. Prev Med. 2017;105:212-218.
  13. Palmer et al. Arch Intern Med. 2008;28(168):1487-1492.
  14. The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center. Risk Factors for Type 2 Diabetes. National Institutes of Health. https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes
  15. Chen et al. Diabetes Care. 2012;35(5):1079-1082.
  16. O’Neil et al. Nutr Res. 2011;31(9):673–682.
  17. Lamb et al. Diabetologia. 2015;58(9):2027-2034.
  18. Pereira et al. J Am Coll Nutr. 2010;29(6):625-629.
  19. Basile et al. Proc Fla State Hort Soc.2010;123:228–233.
  20. Morand et al. Am J Clin Nutr. 2011;93:73–80.
  21. Cesar et al. Rev Nutr. 2010b;23:779-789.
  22. Foroudi et al. J Medicinal Food. 2014; 17(5):612-617.
  23. Dourado et al. Food Nutr Res. 2015;59:28147.
  24. Ghanim et al. Am J Clin Nutr. 2010;91(4):940–949.
  25. Chaves et al. J Proteome Res. 2017;16(11):4086-4092.
  26. Simpson et al. Food Func. 2016;7:1884-1891.
  27. Ribeiro et al. 2017;38:13-19.
  28. Codoner-Franch et al. Acta Paediatr. 2010;99(12):1841-1846.
  29. Murphy et al. J Nutritional Sci 2017;6(59):1-15. https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1017%2Fjns.2017.63
  30. Auerbach et al. Adv Nutr. 2018;9(2):78-85. https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1093%2Fadvances%2Fnmx006
  31. Moreira et al. Food Res International 2018;107:346-352.  https://doi.org/10.1016/j.foodres.2018.02.046
  32. Li et al. Nutrients. 2017:9(1).  https://www.ncbi.nlm.nih.gov/pubmed/?term=10.3390%2Fnu9010032
  33. Busing Clin Nutr. 2018 Mar 3. pii: S0261-5614(18)30093-1. https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1016%2Fj.clnu.2018.02.028