(P07-014-23) Age of Juice Introduction and Cardiometabolic Outcomes in Middle Childhood

Objectives: The American Academy of Pediatrics recommends juice introduction after 12 months of age, although we previously found most children are introduced to juice before. Fruit juice consumption has been linked to childhood obesity and metabolic syndrome. We examined the relationship between the age of juice introduction and cardiometabolic outcomes in 8–10-year-old children.

Methods: We included 422 children from the Upstate KIDS follow-up study in New York State between 2017-2019. Parents reported the age of juice introduction on questionnaires at 4, 8, 12, and 18 months of age. Staff measured anthropometry, blood pressure (BP), and arterial stiffness by pulse wave velocity (PWV) during clinic visits. Age- and sex-standardized anthropometric z-scores were calculated using the CDC reference. Plasma lipids, hemoglobin A1c (HbA1c), and C-reactive protein (CRP) in a subset of children were also measured (n=214). Associations between juice introduction (categorized as < 6, 6-12, ≥ 12 months) and outcomes were estimated using linear models applying generalized estimating equations to account for correlations between twins.

Results: About 19% of children were introduced to juice < 6 months, 52% between 6-12 months, and 29% ≥ 12 months of age. Children who were introduced to juice < 6 months had higher BMI z-scores (0.55; 95% CI: 0.21, 0.88), weight z-scores (0.45; 0.16, 0.74), and waist circumference (3.48 cm; 0.78, 6.18) compared to those introduced ≥ 12 months. Introduction between 6-12 months was also associated with higher BMI (0.23; 0.01, 0.46) and weight (0.23; 0.003, 0.46) z-scores, but associations were no longer significant after adjusting for socioeconomic factors and maternal BMI. Nevertheless, introduction to juice < 6 months was associated with higher systolic BP (3.30 mmHg; 0.64, 5.96), mean arterial pressure (2.08 mmHg; 0.20, 3.96), and heart rate (5.25 bpm; 2.08, 8.41) compared to those introduced ≥ 12 months even after covariate adjustment. No significant differences in lipids, HbA1c, and CRP levels were found.

Conclusions: Introduction to juice < 6 months of age was associated with selected cardiovascular measures, although whether concurrent diet mediates these associations will be explored.

Funding Sources: Supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Health of Child Health and Human Development