After a survey of more than 370 000 US adults comparing whole fruit and juice habits across cardiovascular diagnoses – with a closer look at which differences persist after adjustment – the researchers concluded that those with high BP and high cholesterol had lower whole fruit consumption frequency than the groups without high blood pressure and high cholesterol.
Their findings were reported in the journal Current Developments in Nutrition.
As high blood pressure and high cholesterol are leading risk factors for CVD and whole fruit consumption is associated with reduced likelihood of these risk factors, they said their findings also align with previous research that individuals who had experienced heart attack, angina or CHD, and stroke had lower fruit consumption frequency.
For the study, the researchers – led by the Department of Nutrition and Dietetics at the University of North Dakota – examined differences in the frequency of whole-fruit and 100% fruit-juice consumption between individuals with and without cardiovascular disease (CVD) or CVD risk factors in the United States.
The 2020-25 Dietary Guidelines for Americans (DGAs) recommend two cup-equivalents of fruit per day for a 2 000-calorie dietary pattern. The 2025-30 DGAs retain that recommendation while advising people to limit and dilute juice. Yet a majority of the population (~80%) fails to meet the recommended levels, consuming less than one cup of fruit per day.
Whole fruit accounts for about half of reported fruit intake in the US, according to figures cited by the authors.
The fibre, nutrients, and bioactive compounds in whole fruit may work together to support health. Higher fruit consumption has been associated with a lower risk of various chronic diseases, including CVD.
While the relationship between whole fruit intake and CVD risk is well known, the relationship between fruit juice and CVD remains less clear. How the consumption frequencies of whole fruit and fruit juice differ between people with and without CVD or CVD risk factors is also uncertain.
In the present study, the scientists used data from the Behavioural Risk Factor Surveillance System (BRFSS), a series of telephone-based surveys that collect data on chronic conditions, access to care, use of preventive services, and risk behaviours among US residents.
Using data from the 2019 BRFSS, which included 418 268 adults, the team performed a secondary analysis of the data to examine whether the frequencies of whole-fruit and fruit-juice consumption differed between people with and without CVD and between those with and without CVD risk factors.
CVD measures included myocardial infarction (heart attack), angina/coronary heart disease (CHD), and stroke. CVD risk factors included self-reported high cholesterol and high blood pressure (BP). Independent-samples t-tests and regression models were used to evaluate whether the mean frequencies of whole-fruit and fruit-juice consumption differed between groups with CVD risk factors or CVD and those without.
Regression analyses were controlled for age, race or ethnicity, education, smoking status, and income.
Findings
In total, 371 038 BRFSS respondents were included. Based on survey-weighted percentages, just more than half were female (51%), 62.3% were non-Hispanic white, and those aged 65
or older formed the largest age category (21.8%).
On average, fruit juice was consumed 0.3 times per day, while whole fruit was consumed 1.06 times per day. These figures describe frequency, not the number of cups or servings consumed. In the respective analyses, 151 983 respondents reported high blood pressure, and 130 399 reported high cholesterol. Further, 21 603, 21 151, and 16 489 respondents reported a heart attack, angina/CHD, and stroke, respectively.
In the initial comparisons, the frequency of fruit juice consumption was higher among individuals with high BP, a heart attack, stroke, or angina/CHD compared with those without the respective CVD risk factor or condition. It was lower in subjects with high cholesterol than in those without.
Whole-fruit consumption was less frequent in respondents with high BP, high cholesterol, a heart attack, CHD, or stroke compared to groups without the respective CVD risk factor or condition.
In regression analyses, participants with high cholesterol consumed fruit juice less frequently, whereas those with a heart attack consumed it more frequently. Fruit juice consumption frequency did not differ significantly after adjustment between individuals with and without high BP, stroke, or CHD.
After adjustment, whole-fruit consumption was less frequent among participants reporting high BP, high cholesterol, CHD, or a heart attack.
The initial whole-fruit difference between those with and without stroke did not persist after adjustment. The differences in consumption frequency were small. These comparisons cannot establish whether dietary habits preceded the reported diagnoses.
Less frequent
Collectively, individuals with less favourable CVD status (high BP, high cholesterol, CHD, or a heart attack) reported less frequent whole-fruit consumption; adjusted fruit-juice differences remained only for high cholesterol and heart attack, in opposite directions.
The study’s limitations include its cross-sectional design (which precludes causal inference) and the possibility of respondents misclassifying sugar-sweetened beverages as fruit juice.
Consumption may also have changed after a diagnosis.
The survey measured how often participants consumed fruit and juice, not how much they consumed on each occasion, and its respondents were not representative of the US population. The study controlled for several demographic factors and smoking but did not account for some lifestyle factors, including physical activity, body mass index, and whole-grain and vegetable intake.
The study also did not assess comorbidities or address potential overlap between whole-fruit and fruit-juice consumers
Further studies may investigate how CVD status influences fruit consumption and define strategies to promote fruit intake.
Study details
Examining the Differences in Frequency of Whole Fruit or 100% Fruit Juice Intake among US Adults With and Without Cardiovascular Disease Risk Factors: Analysis of 2019 Behavioural Risk Factor Surveillance System Data
Brendan Kesler, Julie Hess, Anne Bodensteiner et al.
Published in Current Developments in Nutrition in September 2026
Abstract
Background
Nearly 80% of Americans do not meet recommendations for fruit, an important source of fibre, potassium, and vitamin C. In the 2020–2025 Dietary Guidelines for Americans, the fruit group included whole fruit (fresh, frozen, dried, and canned) as well as 100% fruit juice (“juice”). Approximately half of reported fruit intake comes from whole fruit (“fruit”), whereas the other half comes from juice, sugar-sweetened beverages, and diet beverages.
Objectives
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 371 038 United States adults from the 2019 Behavioural Risk Factor Surveillance System were 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 used 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 socio-demographic characteristics, significant differences in juice intake frequency remained only for high cholesterol and heart attack.
Conclusions
Adults with less favourable 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 United States population.
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