Sir,- I found Dr Moynihan's article (BDJ 2002; 193: 563–568) on dietary advice in general dental practice a model of clarity, in an area that suffers from public confusion and experts apparently disagreeing with each other1. However, I am concerned that the messages given by Dr Moynihan may conflict with the Government's advice on increasing children's fruit and vegetable consumption.

There is no dispute between dentists and nutritionists about the desirability of consuming whole fruit between meals, as a means of reaching the Department of Health's five portions a day target, but the crunch seems to come when considering fruit juice and dried fruit as suitable alternatives. Dr Moynihan states that fruit juice is both potentially cariogenic and capable of causing erosion, and that dried fruit is likely to be more cariogenic than fresh fruit. However, the Department of Health's guidance on the School Fruit Scheme2 lists both fruit juice and dried fruit as portions that count towards the target - accompanied by photographs of these products. The Food Standards Agency meanwhile3 cautions against fruit juice between meals for children, but enthusiastically states that 'dried fruit is a healthy choice if you want a snack, because it's full of fibre and vitamins'.

Would Dr Moynihan and/or the Department of Health like to comment on whether schools should or should not offer or encourage the consumption of fruit juice and dried fruit at school break-times? I suspect that oral health promotion professionals liaising with schools at a local level might find this helpful.

Dr Moynihan responds:-

The consumption of fruit and vegetables by school children in the UK is undesirably low 4 and the School Fruit Scheme as a means to address this is commendable and welcomed. However, the letter received from Catherine Stillman-Lowe has raised an important question as to whether fruit juice and dried fruit should be encouraged as choices for the School Fruit Scheme. For schools these may be preferable choices over fresh fruit due to advantages of a prolonged shelf life and the guaranteed quality of the product. However, from a dental health perspective these items are not desirable and for the Department of Health to be encouraging their use in the School Fruit Scheme conflicts with other Department of Health advice concerning dental health.

The Committee on Medical Aspects of Food Policy report 'Dietary sugars and Human Disease'5 clearly recommends that the consumption of NME sugars should be decreased and replaced with fresh fruit, vegetables and starchy staple foods. It also states that those providing food for communities should seek to reduce the frequency with which 'sugar snacks' are consumed. Despite this report being over a decade old it has not been superseded and other expert reports likewise recommend that intake of NME sugars should be reduced and avoided between mealtimes6,7.

The Food Standards Agency (FSA) state that fruit or vegetable juice may contribute one portion towards the recommended five a day; so regardless of how much is consumed, fruit/vegetable juice may only count as one portion. This is because fruit/vegetable juice does not contain all the beneficial plant cell wall materials and non-starch polysaccharide (fibre) that whole fruits and vegetables do.Fruit juices contain approximately 10% NME sugars and dried fruits are approximately 70% sugars. The method used by the FSA to estimate the NME sugars content of foods, assumes that 50% of sugars in dried fruits are NME sugars (personal communication), therefore dried fruit (e.g. raisins) are approximately 35% NME sugars; a level comparable with sugared breakfast cereals, biscuits and cakes and certainly a level high enough to classify dried fruit as a 'sugar snack'. It is clear therefore that in order to follow current recommendations for dental health, that fruit juices and dried fruits should not be encouraged as part of the School Fruit Scheme.

P. Moynihan

Newcastle