Examining the Differences in Frequency of Whole Fruit or 100% Fruit Juice Intake among United States Adults With and Without Cardiovascular Disease Risk Factors: Analysis of 2019 Behavioral Risk Factor Surveillance System Data

Background Nearly 80% of Americans do not meet recommendations for fruit, an important source of fiber, potassium, and vitamin C. In the 2020-2025 Dietary Guidelines for Americans, the fruit group included whole fruit (fresh, frozen, dried, canned) as well as 100% fruit juice ("juice"). Approximately half of reported fruit intake comes from whole fruit ("fruit") while the other half comes from juice, sugar-sweetened beverages, and diet beverages. Objective The objective of this study was to investigate whether frequency of fruit or juice intake differs among adults with and without cardiovascular disease (CVD) or CVD risk factors. Methods Data from n=371,038 U.S. adults from the 2019 Behavior Risk Factor Surveillance System was used to identify consumers of fruit and juice, frequency of fruit or juice intake, and those with high blood pressure, elevated blood cholesterol, angina/coronary heart disease (CHD), heart attack, or stroke. Independent sample t-tests and linear regression were utilized to determine whether mean fruit consumption or juice consumption frequency differed between groups with and without CVD or CVD risk factors. Results Fruit consumption frequency was lower in adults who self-reported high blood pressure (p<0.0001), high cholesterol (p<0.0001), heart attack (p<0.0001), CHD (p=0.0020), or stroke (p<0.0001), before and after controlling for age, education, income, and smoking. Juice consumption frequency was higher in adults who self-reported high blood pressure (p<0.0001), heart attack (p<0.0001), CHD (p=0.0166), or stroke (p<0.0001). After controlling for sociodemographic characteristics, significant differences in juice intake frequency remained only for high cholesterol and heart attack. Conclusions Adults with less favorable CVD status reported lower fruit intake frequency and, for some indicators, differences in juice intake frequency. Additional research is warranted to examine how CVD status affects fruit intake frequency, pinpoint potential mechanisms, and identify strategies to increase fruit consumption in the U.S. population.