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04.11.2020 | Original Contribution | Ausgabe 5/2021 Open Access

European Journal of Nutrition 5/2021

100% Fruit juice intake and cardiovascular risk: a systematic review and meta-analysis of prospective and randomised controlled studies

European Journal of Nutrition > Ausgabe 5/2021
Lanfranco D’Elia, Monica Dinu, Francesco Sofi, Massimo Volpe, Pasquale Strazzullo, The SINU Working Group, Endorsed by SIPREC
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00394-020-02426-7) contains supplementary material, which is available to authorized users.
The members of “The SINU Working Group (Italian Society of Human Nutrition (SINU), 20126, Milan, Italy)” are listed in acknowledgement section.
The paper was endorsed by SIPREC (Italian Society for the Cardiovascular Prevention (SIPREC), 00197, Rome, Italy)



The relationship between 100% fruit juice (100%FJ) consumption and cardiovascular risk is object of debate: indeed, recently published investigations provided new but discrepant evidence on this important question and International dietary guidelines are not in agreement on recommendations about fruit juice consumption. Therefore, we performed a meta-analysis of the prospective studies and the randomised controlled trials (RCTs) that explored the relationship between 100%FJ intake, cardiovascular risk profile and risk of cardiovascular events.


We performed a systematic search of publications up to August 2019. Summary relative risks and exploration of linearity of the association were estimated for prospective studies and summary mean differences (MDs) calculated for RCTs.


A total of 21 prospective studies and 35 RCTs met the inclusion criteria. Dose–response analysis detected a significant inverse association between low-moderate 100%FJ consumption and risk of stroke (up to 200 ml/day) or total CV events (up to 170 ml/day) compared with no consumption, with a non-linear relationship (p for non-linearity < 0.05). No significant association was found for coronary heart disease and diabetes risk. In RCTs, a favorable and significant effect of 100%FJ intake was detected on blood pressure (systolic, MD: − 3.14 mmHg; diastolic, MD: − 1.68 mmHg), arterial compliance (carotid-femoral pulse wave velocity, − 0.38 m/s) and endothelial function (flow-mediated dilation, 2.10%). Neutral effects were found on body weight, blood lipids and glucose metabolism.


The results of these analyses indicate that 100%FJ consumption is not associated with higher CV risk. A non-linear inverse dose–response relationship occurs between 100%FJ consumption and CV disease, in particular for risk of stroke, probably mediated by the decrease in blood pressure.

Trial registration

PROSPERO registration number (CRD42019135577).

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