Published: January 2025

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Fruit drinks are the top sources of added sugar in young children’s diets, increasing their risk of chronic disease. It is unclear to what extent front-of-package (FOP) marketing and disclosures influence parents’ perceptions of fruit drinks and their intentions and decisions to purchase them. These data are needed to inform regulatory and legal action to reduce potentially misleading marketing and help parents make healthier choices for their children. This systematic review investigated the relationship between fruit drink FOP claims (nutrient, natural/implied-natural, health-related), fruit imagery, and ingredient disclosures (sugar, non-nutritive sweeteners, and juice content) and consumer perceptions, intentions, and behavior. A comprehensive search was used to identify peer-reviewed, original quantitative and/or qualitative research published any time. Risk of bias was assessed using the Quality Assessment Tool for Quantitative Studies and the Critical Appraisal Skills Programme checklist for qualitative studies. Articles were grouped by exposure and narratively synthesized. Sixteen articles met inclusion criteria. Reviewed studies found that natural claims-and to some extent, nutrient claims and fruit imagery-are associated with increased selection, purchase intentions, perceived healthfulness, and appeal of fruit drinks; and increased misunderstandings of fruit drink juice content (overestimation) and added sugars content (underestimation). Ingredient disclosures-including percent-juice content and presence of added sweeteners-may help correct misperceptions about product healthfulness. FOP claims and imagery can increase healthfulness misperceptions and selection of fruit drinks, and ingredient disclosures could partially correct those misperceptions. The U.S. Food and Drug Administration should consider updating fruit drink FOP-marketing regulations. More high-quality randomized experiments would be useful to inform federal and legal action to support parents in selecting healthier beverages for their children.

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