This study showed that the percentage of 100% FJ consumers was age dependent; children 2-5 y had the highest percentage of consumers and adolescents 13-18 y had the lowest percentage of consumers. Diet quality, determined by the HEI-2005, was better in all age groups of 100% FJ consumers when compared with non-consumers.
The age variation of the percentage of 100% FJ consumers is consistent with other studies [15, 16]. Reasons for the high prevalence of 100% FJ consumption in children may include participation in the Women, Infants, and Children (WIC) Program by young children  since 100% FJ is a WIC authorized food in three of the food packages for children over 11 months of age . Participation in the National School Lunch or Breakfast Program by older children  may also lead to consumption of 100% FJ since these are approved menu items, and is the only juice product that may be served in the National School Breakfast Program . It is also possible the frequency of consumption is lowest in adolescents since they are the least likely age group to consume breakfast  and 100% FJ is thought of as a breakfast food by many consumers. Adolescents who participate in the National School Lunch program also have more beverage options than elementary school children  have and may not choose 100% FJ. Studies have also shown a secular decline in consumption of 100% FJ by adolescents over the past five years .
MyPyramid  and AAP  recommendations state that 100% FJ can be part of a healthy diet when served in age appropriate amounts. This study showed that the usual intake for children 2-5 y exceeded these recommendations. Further studies are needed to assess the health effects of consuming higher than recommended levels of 100% FJ, and whether consuming whole fruit without 100% FJ provides an advantage to consumers. Recommendations for 100% FJ consumption vary; thus, caretakers and consumers may be confused and efforts should be made to reconcile the recommendations using an evidence-based approach.
MyPyramid recommendations were established, in part, to encourage fiber intake since modeling studies by the USDA showed that when 100% FJ was replaced by whole fruit, fiber intake increased by nearly 37% . Regression analysis did show a modest, but significant contribution of fiber to the diet from 100% FJ in all but the youngest age group. That there was no difference in fiber intake between 100% FJ consumers and non-consumers suggests that other foods were contributing fiber to the diet. Usual fiber intake was, however, below the Institute of Medicine's recommendations  in all age groups in 100% FJ consumers and non-consumers and foods rich in fiber should be encouraged.
The rationale for the AAP recommendations for 100% FJ consumption in children and adolescents is not completely clear, but is in part based on one study that showed an association of 100% FJ consumption and overweight in pre-school aged children . Although concerns about overweight/obesity and consumption of 100% FJ appear unfounded , it is important to consume 100% FJ with other foods while maintaining energy balance. Paradoxically, in all age groups except children 2-5 y, the group that consumed the most 100% FJ, energy was higher in 100% FJ consumers. The relationship of weight and 100% FJ consumption was not examined in this study.
Previous studies have shown that children  and adolescents  also had higher intakes of total fruit and adolescents had higher intakes of citrus, melons, and berries. These studies have not been conducted in adults. Moreover, studies have not examined the effect of 100% FJ intake on overall diet quality. The HEI-2005, used to assess diet quality, was revised to reflect the 2005 Dietary Guidelines . The HEI-2005 now reflects all components of the MyPyramid eating plan, including grains/whole grains, fruit/fruit juice, variety in vegetable and fat types, non/low fat dairy, sodium, and discretionary calories . Traditionally, population HEI-2005 scores have been used with a single 24-hour dietary recall , but recently it was shown that it could also be used when multiple recalls were available .
The HEI-2005 scores for this population were lower than those shown for individuals 2+ y in 2003-2004 . However, the overall scores of those consuming 100% FJ were significantly higher than those not consuming juice. Consumption of 100% FJ improved total HEI-2005 scores in all age groups; by choosing to consume this single food, the HEI-2005 score improved approximately 10%. However, the total HEI-2005 scores calculated in this study both with and without 100% FJ consumption were still low and needed improvement.
Consumers of 100% FJ also had improved intake of whole fruit. When assessing consumption levels, many studies have combined the intake of fruit and vegetables; however, those studies reporting fruit separately have shown that children, adolescents, or adults [4–6, 51] did not meet the fruit recommendation. Data from the 2003-2004 NHANES showed that adult females had the highest percentage (12.3%) of those meeting the fruit recommendation; only 8.6% of adult males met the recommendation . For both genders, the median number of servings consumed was 0.61 per day . Overall consumption was lowest in pre-adolescent, adolescent, and young adult males . Despite extensive, coordinated public health campaigns by government and industry , fruit consumption remains low. Consumption of 100% FJ appears to be one way to increase fruit intake; however, the goal should be to encourage intake of all types of fruit.
One concern about consumption of 100% FJ in children and adolescents is that it may replace fluid milk in the diet . Regression analyses showed that there was no difference in the HEI-2005 Milk component score between consumers and non-consumers of 100% FJ. This supports findings from previous studies that consumption of 100% FJ was not associated with lower consumption of milk in the diets of children [15, 16].
This study did show that in adolescents 13-18 y consumption of 100% FJ was also associated with higher intake of total, saturated, and discretionary fats. Reasons for this are not clear, but may reflect the overall poor eating habits reported in this age group [43, 54]. Additional studies are needed to determine factors leading to poor diet quality in adolescents.