Does apple juice and non diet soda consumption lead to asthma?

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Dear Parents,
Not that many years ago it was common to see children walking around with bottles of juice; at times actively drinking, but more frequently  just hanging out from their mouths, and frequently causing bottle caries. I don't know how many of you have seen children with bottle caries, but it is not a pretty sight. From the way these children's teeth look, the appearance is that of a child from a third world undeveloped country. It is for this reason that with rare exception, drinking juice from a bottle is discouraged in children, and juice is withheld from infants until 6 or 7 months of age when a child can sit well and grasp a cup.

Back in 1997 the Academy of Pediatrics (AAP) issued a policy statement discouraging children from drinking an excess amount of juice; as a study at that time demonstrated that doing so contributed to obesity and short stature.  On the evening news, and many talk shows we heard that if we did not want short fat children , we should not feed them more than 5 oz. a day of fruit juice. For more information on this you may click on the following link:
<  Excess fruit juice consumption by preschool-aged children is associated with short stature and obesity. >

The most recent theory regarding the possible ill effects of excess free fructose (EFF) contained in apple juice (apple juice contains 90% fructose,10% glucose), and non diet sodas, and other juice drinks which contain high fructose corn syrup (HFCS) is as follows. You can similarly click on the link to reference the original study: 

In situ intestinal formation of advanced glycation end products (enFruAGE) arising from high intake of excess free fructose (EFF) has been suggested as a possible mechanism for EFF-associated childhood asthma(8). Recently, an important role for the receptor of advanced glycation end products (RAGE) in mediating asthma has been suggested(9). This supports the possibility that advanced glycation end products (AGE) – known ligands of RAGE – might contribute to asthma pathogenesis.


In short the study demonstrated that children ages 2-9 years who consumed excess free fructose (EFF),that is, beverages such as apple juice, fruit juice drinks sweetened with HFCS as well as non-diet sodas 5 times or more a week had an incidence of asthma greater than 5 times that of children who consumed the same beverages one or less times a month. The fact that these results were not demonstrated in older children may be due to tolerance developed as children mature. Orange juice consumption (as opposed to apple juice consumption) actually showed a possible protective effect to the development  of asthma in 2-9 year old children. We may consider therefore a prudent quantity of oranges and orange juice in our children's diet, but should keep in mind the deleterious effects of an excess amount of all sugars to our bodies and the possible consequences of obesity and diabetes mellitus. Similarly acidic foods in small children may at times contribute to diaper rash, and citrus does have an increased risk of allergy.

The rate of asthma in the US has risen in epidemic proportions since the year 1980, increasing 80% in school children between 1980 and 1994 and 160% in preschool children during those same years.
The etiology  for this epidemic is of course multifactorial, but the consumption of EFF can not be ignored as one of many causes for this epidemic.

Fruit juice do provide  children with  fluids and vitamin C, and at times may help in keeping children's bowel habits regular, however, we should definitely consider substituting water for fruit juice in our children's diets whenever it is feasible to do so. 


 

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Sincerely,
Howard Nass MD FAAP and staff

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TO APPLE JUICE OR NOT TO APPLE JUICE; THAT IS THE QUESTION