摘要：The Healthy Hunger-Free Kids Act of 2010 presents an opportunity to change the nutritional quality of foods served in low-income childcare centers, including Head Start centers. Excessive fruit juice consumption is associated with increased risk for obesity. Moreover, there is recent scientific evidence that sucrose consumption without the corresponding fiber, as is commonly present in fruit juice, is associated with the metabolic syndrome, liver injury, and obesity. Given the increasing risk of obesity among preschool children, we recommend that the US Department of Agriculture’s Child and Adult Food Care Program, which manages the meal patterns in childcare centers such as Head Start, promote the elimination of fruit juice in favor of whole fruit for children. CHILDHOOD OBESITY HAS reached epidemic proportions in the United States. By age four, 18.4% of all children are obese, with a body mass index (BMI; defined as weight in kilograms divided by height in meters squared) in the 95th percentile or greater for age and gender. There is an even greater prevalence among Hispanic (22.0%), American Indian or Alaska Native (31.2%), and non-Hispanic Black children (20.8%) than among non-Hispanic White children. 1 Among older children, the greatest increase in the prevalence of obesity has been in those in low-education, -income, and -employment households that have sustained increases from 22% to 33% from 2003 to 2008. 2 Per capita daily caloric intake increases in beverages, particularly sugar-sweetened beverages and 100% fruit juices, parallel the surge in childhood obesity in the United States. 3 Additionally, studies document the association between excessive consumption of fruit juice and an increased risk for childhood obesity and short stature. 4 To address the obesity epidemic in children and the simultaneous increase in caloric intake from beverages, the Special Supplemental Program for Women, Infants, and Children changed the food package in 2009 for the high-risk children who the program serves to eliminate fruit juice for infants younger than 12 months and to limit juice consumption to less than four ounces a day for children older than one year. 5 In this article, we have argued that the rapid increase in obesity among American children necessitates a more aggressive approach, for example, to limit high caloric beverages such as 100% fruit juice, particularly among young children, who are first developing eating behaviors and practices. A unique opportunity to reshape the eating and drinking habits of high-risk US children presents itself in the forms of the Child Nutrition and WIC Reauthorization Act and the Healthy, Hunger-Free Kids Act. 6 The Healthy, Hunger-Free Kids Act is designed to target the nutritional health of high-risk, low-income children younger than five years, including those participating in the Child and Adult Food Care Program (CAFCP), which includes Head Start and other low-income daycare centers. The US Department of Agriculture (USDA) is mandated to develop, as early as fall 2013, updated meal patterns and nutrition standards for CAFCP meals and snacks that reflect current relevant science. 7 Additionally, the secretary of agriculture is required to provide nutrition guidance to childcare centers and states by January 1, 2012, to ensure increased consumption of such foods as fresh, canned, and frozen fruits. 7 We recommend that the CAFCP meal patterns and nutrition standards include the removal of 100% fruit juice from the CAFCP programs to counter increases in fruit juice consumption among US preschool children and in line with recent science that underscores the danger of fructose consumption without concurrent fiber in contributing to childhood obesity. Our recommendations also parallel the act’s mandate that only low-fat milk options be served to children older than two years, that water be made readily available and accessible, 7 and that CAFCP programs adhere to the limits placed on 100% fruit juice by professional organizations and institutes in the past 10 years.
