A healthy diet is crucial in preventing non-communicable diseases (NCDs) like heart disease, diabetes, and cancer, as unhealthy eating habits (high sugar, high saturated fat, high salt, low fruit, and low vegetable consumption) contribute to the development of NCDs (1). Identifying and promoting effective dietary patterns is crucial for improving public health due to the ability of a healthy diet to improve overall health and longevity while reducing healthcare costs (2). Although a substantial number of studies have examined various aspects of diet ranging from vegetables and meat to sugar and fat, certain food groups — particularly fruits — are often overlooked. Fruits serve as excellent sources of essential nutrients, fiber, and antioxidants, which can contribute to overall health and wellbeing by supporting digestion, boosting the immune system, and protecting against chronic diseases (3). However, most studies analyze fruit and vegetable consumption rather than just focusing on fruits, leaving the relationship between fruits and health outcomes in question (4). For example, a systematic review analyzing fruit and vegetable intake performed a meta-analysis of 142 studies, 24 of which focused solely on fruit consumption (5). However, all of these studies focused on fruit consumption as a whole and failed to consider that there are various unique methods of ingesting fruits, such as drinking fruit juices, drinking fruit smoothies, or eating solid fruits.

Solid fruits — whole, raw, or minimally processed (i.e., sliced/chopped) — are traditionally considered to be the best way to consume fruits, although dietary guidelines insist that all fruit consumption forms are equal (6). Moreover, many believe 100% fruit juices (juice derived solely from fruits) and fruit smoothies (blended fruits) to be equally nutritious as solid fruits, which is consistent with dietary guidelines (7). The validity of such beliefs must be assessed via scientific research. Fruit juice is the liquid extracted from a fruit while a fruit smoothie is the blended beverage made from the entire fruit and retains fiber, pulp, and other solids. This difference in juicing vs. blending is believed to cause variation in the respective glycemic indices of fruit juices and fruit smoothies. However, as an umbrella review study shows, there is a limited number of studies examining multiple fruit consumption forms. An umbrella review study, which found decreased incidence of cardiovascular disease, stroke, congenital heart disease, and oral cancer, examined 77 meta-analyses — of which only one was regarding an alternate fruit consumption form to solid fruits or fruits in general (8).

In addition, there is an ongoing scientific debate regarding the efficacy of fruit juices, with some studies linking them to metabolic issues and increased incidence of diabetes/hyperglycemia and other studies showing positive effects. While some studies have found an increase in cardiovascular disease mortality associated with fruit juice consumption (9), others found fruit juices to correlate with decreased cancer, hypertension, and cardiovascular disease incidence (10). Furthermore, there is a paucity of research comparing the different fruit consumption types, particularly fruit smoothies, on various measures of health. For example, the only studies examining the health outcomes of fruit smoothies focus on one or two specific types of fruits (e.g., raspberries, nutraceutical fruits) or on one specific health outcome (e.g., psychological distress) (11). Additionally, public health campaigns and dietary guidelines often overlook misconceptions about fruit juices, treating all forms of fruit equally despite evidence that processing alters nutrient composition and glycemic response, potentially leading to overconsumption (12).

This study aims to refine dietary recommendations by examining how different forms of fruit consumption — solid fruits, fruit juices, and fruit smoothies — uniquely impact various health outcomes, including chronic diseases, mental health, sleep quality, energy levels, and medical resource use. While prior research has established the benefits of fruit consumption, it often generalizes all forms of fruit as equally beneficial, failing to consider how processing may influence nutrient composition and health effects. By employing a survey-based methodology, this study provides a more comprehensive analysis of physical and mental health factors, lifestyle habits, and medical usage, addressing gaps in prior research that typically focus on limited outcomes like cardiovascular disease or body mass index (BMI). The findings could enhance dietary guidelines by promoting specific fruit consumption patterns for optimal health and cognitive function. Given the potential public health implications, this study underscores the importance of differentiating between fruit consumption types to guide more precise nutritional recommendations. The following methods section details the study’s design, participant selection, and analytical approach, ensuring a thorough investigation of these associations.

As previously mentioned, this study applies a novel approach by examining the different forms of fruit consumption (solid fruits, fruit juices, fruit smoothies) and their associations with a wide variety of health outcomes ranging from chronic/lifestyle conditions to self-assessments of personal health. Given the knowledge that a healthy lifestyle (healthy dietary patterns and physical activity) can prevent many non-communicable diseases (NCDs), it is important to clearly identify the most effective dietary patterns in order to minimize the risk of developing NCDs (14). The overarching goal of this study is to inspire more focused causal research in the field of dietary healthy, while also promoting the increased specificity of dietary guidelines, such as clearly elucidating the distinctions between fruit consumption forms.

Prior to analyzing the data and compiling the results of this study, it was hypothesized that solid fruits would be the healthiest option, with fruit smoothies and fruit juices being the second and third best options, respectively. Fruit smoothies and fruit juices have lower energy intakes than solid fruits, suggesting that they might not be as beneficial (12, 15). However, this was not quite the case, as the fruit smoothies group was associated with the best health outcomes.

The key findings of our study reveal that the low fruit consumers group had the worst health outcomes, while the fruit juices group had the second worst. The fruit smoothies group had the lowest percentage of prescription medication use (23.26%), while the fruit juices group had the most (61.86%). The fruit juices group had the highest percentage of high cholesterol (39.18%) and second highest percentage of hypertension (32.99%). The fruit smoothies group had the lowest prevalence of hypertension (18.60%), while the low fruit consumers group (40.72%) had the highest. The low fruit consumers and fruit juices groups had the highest (16.17%) and second highest (13.40%) prevalence of cardiovascular diseases, respectively.

As seen in a longitudinal analysis study, low fruit consumption and high fruit juice consumption are both correlated with all-cause mortality in women with cardiovascular diseases (16). Nonetheless, a systematic review study found no correlation between fruit juice consumption and coronary heart disease or diabetes, despite finding that 100% fruit juice consumption resulted in decreased blood pressure (17). Additionally, this study reported a non-linear dose-response relationship between 100% fruit juice consumption and decreased risk of stroke and cardiovascular events (17). Conversely, authors found the consumption of high excess free fructose beverages (such as fruit drinks and juices) to be associated with increased prevalence of coronary heart disease (18). However, these researchers failed to differentiate between 100% fruit juices, fruit drinks that include added sugars or preservatives, and soft drinks. The congregation of fruit consumption types with varying levels of postulated healthiness, combined with the focus on merely a couple of health outcome variables, reveals the necessity of a research paper with clearly defined fruit consumption groups and numerous diverse health outcomes.

Expanding upon these sundry health outcomes, our study reveals that the fruit smoothies group and solid fruits groups had the lowest (12.79%) and second lowest (16.13%) frequency of mental health struggles, respectively. While past studies have shown that raw fruits and vegetables impact mental health more positively than processed ones (19), they lacked a comparison with a blended smoothie form of fruits (20). Furthermore, even though the fruit juices group had the highest prevalence of diabetes by far (58.76%), the fruit smoothies group had the highest percentage of people with high blood sugar (70.93%), followed by the solid fruits group (62.37%). Although fruit juices lack the fiber that solid fruits possess and therefore have a higher glycemic index, fruit smoothies still possess this fiber. Glycemic index (GI) is a scale used to rank carbohydrate-containing foods based on how quickly they raise blood sugar levels after consumption, with a lower score being more favorable. However, the blending of fruits into smoothies breaks down the fruits’ cellular structures (21), usually, but not always, leading to a lower glycemic index according to the results of various studies (22). For example, although apples, berries, and passionfruit showed a decreased GI in smoothie form as compared to their solid form (21, 23), mangos showed no difference, potentially due to their high sugar content relative to other fruits (24). Considering the disagreements between previous literature regarding the relative glycemic indices of solid fruits and fruit smoothies, this study’s results regarding diabetes and high blood sugar might not be extremely generalizable.

Besides high blood sugar and high cholesterol, the fruit smoothies group had the lowest prevalence of chronic conditions, as well as the lowest mean BMI and physician visits. In addition to this, the fruit smoothies group had the lowest musculoskeletal pain (2.48 ± 0.58) and the highest energy levels (4.51 ± 0.70). The low fruit consumers group has the highest musculoskeletal pain (3.39 ± 0.85). While fruit consumption has not been causally linked to muscle recovery (25), it has been shown to decrease lower back pain (26).

The fruit juices group had the lowest energy levels (2.68 ± 0.81) and the worst sleep quality (2.95 ± 0.85), which is consistent with the fact that fruit juices provide the least energy and satiety of the fruit consumption forms (27). The solid fruits group had the best sleep quality (4.32 ± 0.80), keeping in line with the notion that fruit consumption two hours before bedtime promotes sleep (27).

Moreover, the order of average self-assessed overall health from least to greatest in the four fruit consumption groups was as follows: low fruit consumers (3.14 ± 0.91), fruit juices (3.72 ± 0.84), solid fruits (4.16 ± 0.78), fruit smoothies (4.54 ± 0.71). Interestingly, the average overall health rankings of the groups align precisely with their relative healthiness, as indicated by the observed health outcomes. A previous research study revealed the fruit smoothies can have increased nutrient bioavailability compared to solid fruits, as the breaking of cell walls via blending enables the body to absorb nutrients more efficiently (21). In addition to this, a fruit smoothie of a mix of fruits has a lower glycemic index than that same mix of fruits in their solid form (24). These factors may help explain why the fruit smoothies group exhibited the most favorable overall health profile. By retaining the fiber naturally present in solid fruits while also enhancing access to polyphenols, carotenoids, and other bioactive compounds, smoothies may promote satiety, improve postprandial glucose response, and support cardiometabolic health more effectively than juices (28–30). Blending may also facilitate the release of micronutrients such as vitamin C and folate, which contribute to antioxidant activity and overall metabolic function (31, 32). Additionally, individuals who regularly consume fruit smoothies may be more health-conscious in general, which could partially contribute to the observed associations (33). While fruit smoothies are correlated with better health outcomes in this study, as well as some other research studies, the desire to follow healthy dietary and lifestyle patterns (which is correlated with fruit smoothie consumption) could be a potential confounding variable (24).

Relating these findings to current dietary recommendations revealed both consistencies and notable gaps in existing guidance. The DASH (Dietary Approaches to Stop Hypertension) Diet, developed to promote cardiovascular health, emphasizes increased fruit intake and reduced consumption of sugar-sweetened beverages (34). However, it does not clearly distinguish between solid fruits, (100%) fruit juices, and fruit smoothies, instead focusing on eliminating artificially sweetened beverages (35, 36). In our study, individuals in the fruit juice group exhibited the highest incidence of high cholesterol and the second-highest rates of cardiovascular disease and hypertension, whereas previous research has reported that moderate 100% fruit juice consumption may reduce blood pressure and lower stroke risk (17). The DASH Diet provides examples only of solid fruits, and although some clinicians and dietitians incorporate fruit smoothies within its framework, empirical evidence supporting this inclusion is limited (37). Similarly, the Dietary Guidelines for Americans, 2020–2025 do not explicitly reference fruit smoothies, though they highlight the favorable nutritional profile of solid fruits compared to fruit juices (38–40). While our findings generally align with these recommendations, the observed adverse outcomes associated with fruit juice consumption and the scarcity of research on smoothies emphasize the need for clearer, evidence-based distinctions among fruit consumption forms in future dietary guidelines.

While performing experiments to elucidate causality between variables is important, correlational studies provide suggestions for potential causations, enabling researchers to efficiently narrow down their experiments. Correlational studies, like this one, are unable to control for confounding variables, like physical activity, overall diet quality, and socioeconomic status. However, because this study uses a cross-sectional design, temporality can not be established, and therefore no causal inferences can be drawn. This also raises the possibility of reverse causation (for example, individuals with existing health conditions may alter their fruit-form choices) as well as unmeasured or residual confounding even after statistical adjustment. Another potential source of error in this study is the reliance upon self-reported data, which is inherently subject to inaccuracies such as recall bias (misremembering information) or social desirability bias (providing answers they believe to be socially acceptable) that might impact the data collected for demographics, fruit consumption, or health outcomes. These self-reported measures may contribute to both random and systematic errors in exposure and outcome classification. Additionally, biomarkers or objective health indicators were not measured in this study, potentially limiting the accuracy of the findings. Furthermore, a larger and more diverse participant pool would have provided a more representative analysis of the population, strengthening the generalizability of the results. Because recruitment occurred in public urban settings, the sample reflects convenience sampling, which may introduce selection bias and limit external validity. Another limitation of this study is the lack of quantification of fruit consumption within the various fruit consumption groups, which might have provided novel revelations. Quantifying servings or grams per day would have enabled evaluation of potential dose-response relationships. The survey also did not collect information on the specific fruit types included in each category. Since fruits differ substantially in fiber content, phytochemical composition, glycemic index, and micronutrient density, variations in fruit selection could contribute to the health patterns observed. Future research should distinguish not only between fruit forms but also between the predominant fruits used within each category. Despite these limitations, this research provides useful descriptive and associative insights into fruit-form consumption patterns and highlights the need for longitudinal and experimental studies to more definitively explore these relationships.

Currently, as aforementioned, dietary recommendations do not detail the negative health effects associated with fruit juice consumption that are detailed in this study, and they often do not differentiate between various forms of fruit (solid, juice, smoothie). Also, many research studies do not consider fruit smoothies when discussing the impacts of fruits on health, which, considering this study’s revelation that fruit smoothie consumption is correlated with the best health outcomes, is a severe hinderance to the understanding of dietary science. Furthermore, given the incredible diversity among humans, research exploring tailored dietary recommendations for curtailing the risk of chronic diseases is promising. It is also important for studies to examine other dietary factors, such as the co-consumption of food with fruits, the quantity of fruit consumption, and the quality of the fruit consumed. Longitudinal studies that include biomarker measurements for health outcomes are needed for the assessment of causal relationships. This paper lays a foundation for future studies intended to boost our dietary understanding and promote better overall public health.