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Labels on many children's drink products supposedly containing fruit juice continue to be misleading, despite FDA attempts to regulate them, researchers reported.

An analysis of top-selling products marketed to kids found that nearly all (97%) showed images of fruit on the front of the package -- often depicting fruits not used in the products, and sometimes for drinks that contained 2% or less real fruit juice, Jennifer Pomeranz, MPH, of New York University in New York City and Jennifer Harris, PhD, of the University of Connecticut in Hartford, reported in the .

The labels showed 19 different types of fruit, even though apple juice was the primary ingredient for all products that contained juice. Less than half (45%) of drinks with fruit images on the package actually included juice from the pictured fruits, and 37% did not contain juice from any of the fruits on the packaging.

The study included 39 fruit punch flavored drinks from brands that had sales of at least $10 million in 2018. Of these, seven contained 100% juice. Of the rest, 11 were diluted juices (juice and water), eight contained some juice (less than 100% but more than 2%) with added sugars or low-calorie sweeteners, and eight were 2% or less juice and consisted of flavoring and sugar or low-calorie sweeteners. Finally, five were labeled as water but contained ingredients similar to the drinks with little or no juice.

"For all product categories in this study, FDA regulations permit the naming and use of fruit vignettes that reflect the drink's flavor regardless of the product's ingredients," the study authors wrote. "It is unclear whether consumers understand that fruit flavors, names, and images do not necessarily reflect fruit or juice as an ingredient."

Furthermore, the "statement of identity," a more accurate description of the product that the FDA requires to be a principal feature of the front label, was sometimes difficult to notice or read because of its placement, font size, or color, the study found.

Pomeranz and Harris also found that, for products containing added sugar, cane sugar, or other non-nutritive sweeteners, 60% of labels made positive statements about sweeteners such as "no high fructose corn syrup." And drinks across all categories made vitamin claims such as "100% vitamin C," even though this was due to fortification and not derived from fruit juice.

The FDA issued regulations in 1993 establishing labeling requirement for these products, but potentially confusing labels are still allowed under the rules, the study authors noted. To address concerns about confusing labels, the FDA issued a in 2016 recommending that consumers not rely on product names, pictures on the packing, or the taste of the product to determine what it contains but instead examine the ingredient list. "Thus, even the FDA concedes that its labeling requirements for front of packages... do not clearly convey product and ingredient information to consumers," the researchers said.

"I wholeheartedly agree that labels are often misleading and should be revised," Natalie Muth, MD, of the UCLA Fielding School of Public Health in Los Angeles, and a spokesperson for the American Academy of Pediatrics (AAP), said in an email to 番茄社区app. "We encourage parents to use nutrition labels to make healthy choices for their children, but too often food packagers and marketers provide misleading information on labels, including pictures of fruits in products that actually contain little or no fruit, or front-of-package boasts of containing many vitamins and nutrients, which could be the case but is countered by very high amounts of sugars."

Other food products marketed to kids also have misleading labels, noted Lauri Wright, PhD, director of the clinical nutrition program at the University of North Florida in Jacksonville. "In addition to fruit drinks, fruit snacks are another kid's food product that can be deceiving for similar reasons such as claims containing 'real fruit' or 'all natural,'" Wright, who was not involved in the study, told 番茄社区app. "Cereals are another food product that can be deceiving. They can claim 'made with whole grain' even if the majority of the grains are refined -- and a sugary cereal that's 'made with whole grains' is still a sugary cereal."

Said Muth, "Marketers know that parents want to choose foods that are healthy for their kids but also that kids like," she said. "Kids tend to prefer sweet and salty foods, so marketers have to figure out how to legally promote their product so that it seems healthy (usually by boasting of vitamin content), but oftentimes these foods are high in sugar."

An FDA spokesperson told 番茄社区app, "The FDA typically does not comment on specific studies, but evaluates them as part of the body of evidence to further our understanding about a particular issue and assist in our mission to protect public health. The FDA is reviewing the findings of the paper."

A limitation of the study, Pomeranz and Harris noted, is it included only fruit punch flavored drinks. "However, focusing on fruit-punch flavored products allowed us to compare labeling for seemingly similar drinks across product types," they said, "and we found wide variation in ingredients and nutritional quality."

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