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Diabetes & Metabolic Syndrome
Diabetes and Florida Orange Juice
Note: The information on this site is not intended or implied to be a substitute for medical advice. If you have elevated blood glucose or have been diagnosed with pre-diabetes, Metabolic Syndrome or diabetes, please consult your doctor or a registered dietitian for advice and recommendations concerning your diet.
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:
- In a review of the results of 5 separate studies that included a total of over 286,000 participants, neither 100% fruit juice intake nor citrus juice intake was associated with an increased risk for diabetes in adults. Consumption of 100% fruit juice also was not associated with negative impacts on several risk factors for diabetes, including blood sugar levels and insulin resistance.35
- 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
- 100% fruit juice was not associated with risk for prediabetes or significant effects on glucose metabolism markers such as fasting glucose and insulin, oral glucose tolerance test, HOMA-IR, HOMA-B, and HbA1C in the Hispanic Community Health Study/Study of Latinos cohort.39
- An analysis of over 54,000 participants in the Danish Diet, Cancer and Health Study reported that the intake of total flavonoids was associated with lower risk for incident diabetes, likely mediated by decreased body fat in those who had the highest intake of flavonoids. A sub-analysis found that 100% orange juice had no adverse impact on the risk for incident diabetes.38
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 A small acute study in healthy young women reported no difference in glucose or insulin response when comparing consumption of raw oranges with 100% orange juice or 100% orange juice sweetened naturally with nectar (all matched for total sugars), suggesting that orange juice had no differential glucose or insulin response compared to whole fruit.34
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
A cohort modeling study found that substituting 100% fruit juice for sugar sweetened beverages resulted in a significant decreased risk for several cardiometabolic markers, including type 2 diabetes, cardiovascular disease and coronary heart disease. Modeling a substitution of 100% juice for whole fruit did not result in adverse impacts on any cardiometabolic risk factor. These results suggest that although 100% fruit juice and sugar sweetened beverages have similar sugar content, they are not comparable with regard to cardiometabolic risk and that 100% fruit juice and fruit may be comparable regarding their impacts on cardiometabolic risk.36
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
- HOMA-IR was not significantly different in healthy young women immediately following consumption of whole oranges or 100% orange juice (matched for total sugars).34
- A systematic review and meta-analysis examined 15 randomized controlled clinical trials with a total of 639 study participants related to the impact of 100% orange juice on various cardiometabolic markers. The analysis found that orange juice was associated with lower HOMA-IR levels (i.e., improved insulin sensitivity), but only in studies with healthy subjects and that were at least eight weeks in length.37
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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. Nutrient values may vary based on brand or product types.
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- Wang et al. PLoS ONE. 2014;9:e95323.
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- Fagherazzi et al. Am J Clin Nutr. 2013;97(3):517-523.
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- Palmer et al. Arch Intern Med. 2008;28(168):1487-1492.
- The National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center. Risk Factors for Type 2 Diabetes. National Institutes of Health.
- Chen et al. Diabetes Care. 2012;35(5):1079-1082.
- O’Neil et al. Nutr Res. 2011;31(9):673–682.
- Lamb et al. Diabetologia. 2015;58(9):2027-2034.
- Pereira et al. J Am Coll Nutr. 2010;29(6):625-629.
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- Morand et al. Am J Clin Nutr. 2011;93:73–80.
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- Auerbach et al. Adv Nutr. 2018;9(2):78-85.
- Hagele et al. Nutr Diabetes. 2018;8(1):19.
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