Case 3:23-cv-01446-VC Document 1 Filed 03/28/23 Page 1 of 47
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`FITZGERALD JOSEPH LLP
`JACK FITZGERALD (SBN 257370)
`jack@fitzgeraldjoseph.com
`PAUL K. JOSEPH (SBN 287057)
`paul@fitzgeraldjoseph.com
`MELANIE PERSINGER (SBN 275423)
`melanie@fitzgeraldjoseph.com
`TREVOR M. FLYNN (SBN 253362)
`trevor@fitzgeraldjoseph.com
`CAROLINE S. EMHARDT (SBN 321222)
`caroline@fitzgeraldjoseph.com
`2341 Jefferson Street, Suite 200
`San Diego, California 92110
`Phone: (619) 215-1741
`Counsel for Plaintiff
`
`UNITED STATES DISTRICT COURT
`NORTHERN DISTRICT OF CALIFORNIA
`
`GARY REYNOLDS, on behalf of himself, all others
`similarly situated, and the general public,
`
`Plaintiff,
`
`v.
`
`THE COCA-COLA COMPANY,
`Defendant.
`
`Case No: 23-cv-1446
`
`CLASS ACTION
`
`COMPLAINT FOR VIOLATIONS OF CAL.
`BUS. & PROF. CODE §§ 17200 et seq.; CAL.
`BUS. & PROF. CODE §§ 17500 et seq.; CAL.
`CIV. CODE §§ 1750 et seq.; BREACH OF
`EXPRESS AND IMPLIED WARRANTIES;
`NEGLIGENT AND INTENTIONAL
`MISREPRESENTATION; AND UNJUST
`ENRICHMENT
`
`DEMAND FOR JURY TRIAL
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`Reynolds v. The Coca-Cola Co.
`CLASS ACTION COMPLAINT
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`Case 3:23-cv-01446-VC Document 1 Filed 03/28/23 Page 2 of 47
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`Plaintiff Gary Reynolds on behalf of himself and all others similarly situated by and through his
`undersigned counsel, hereby sues Defendant, The Coca-Cola Company (“Coca-Cola”), and alleges the
`following upon his own knowledge, or where he lacks personal knowledge, upon information and belief,
`including the investigation of his counsel.
`
`INTRODUCTION
`Many of us grew up believing that drinking fruit juice was healthy, and many parents still
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`believe it is healthy. Because whole fruit is healthy it seems sensible that fruit juice, which is derived from
`fruit, would also be healthy.
`But compelling scientific evidence establishes that fruit juice is actually unhealthy because
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`drinking it increases the risk of heart disease, type 2 diabetes, metabolic syndrome, and all-cause mortality.
`Knowing that parents are looking for healthy beverages for their children, the Coca-Cola
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`Company exploits and deceptively perpetuates the misperception that juice is healthy by marketing and
`labeling its Minute Maid Juice Boxes (the “Juice Boxes” or “Products”)1 as being “Good for You!” and “Part
`of a Healthy, Balanced Diet.”
`These and other representations and omissions of material facts are, however, false and
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`misleading, because consuming fruit juices like the Juice Boxes actually increases the risk of chronic
`diseases.
`Accordingly, Plaintiff brings this action against Coca-Cola on behalf of himself and similarly-
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`situated Class Members to enjoin Coca-Cola from deceptively marketing the Juice Boxes, and to recover
`compensation for injured Class Members.
`JURISDICTION & VENUE
`This Court has original jurisdiction over this action under 28 U.S.C. § 1332(d)(2) (The Class
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`Action Fairness Act) because the matter in controversy exceeds the sum or value of $5,000,000, exclusive of
`interest and costs, and at least one member of the class of plaintiffs is a citizen of a State different from
`Defendant.
`
`
`1 The Products consist of Minute Maid Juice Boxes in at least Apple, Apple White Grape, Mixed Berry, Fruit
`Punch, and Lemonade flavors. See Appendix A. To the extent that Minute Maid sold additional flavors during
`the Class Period that Plaintiff’s prefiling investigation was unable to identify, this Complaint should be read
`to include rather than exclude any such flavors of Juice Boxes.
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`Reynolds v. The Coca-Cola Co.
`CLASS ACTION COMPLAINT
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`Case 3:23-cv-01446-VC Document 1 Filed 03/28/23 Page 3 of 47
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`The Court has personal jurisdiction over Coca-Cola because it has purposely availed itself of
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`the benefits and privileges of conducting business activities within California, specifically through
`distributing and selling the Juice Boxes in California and transactions giving rise to this action having
`occurred in California.
`Venue is proper pursuant to 28 U.S.C. §§ 1391(b) and (c), because Coca-Cola resides (i.e., is
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`subject to personal jurisdiction) in this district, and a substantial part of the events or omissions giving rise
`to the claims occurred in this district.
`DIVISIONAL ASSIGNMENT
`This civil action arises out of the acts and omissions of Defendant, which occurred in Alameda
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`County. Pursuant to Civil Local Rule 3-2(c), (d), this action is correctly assigned to the San Francisco or
`Oakland Division.
`
`PARTIES
`Plaintiff Gary Reynolds purchased the Products in California and is a citizen of the state of
`
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`California.
`Defendant, Coca-Cola, is a Delaware corporation with its principal place of business in
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`Atlanta, Georgia.
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`I.
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`FACTS
`COCA-COLA MARKETS THE JUICE BOXES AS HEALTHY
`Coca-Cola is an international conglomerate with a net operating revenue of over $38 billion
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`in 2021.
`Coca-Cola sells the Minute Maid Juice Boxes on a nationwide basis, including in California.
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`Each Juice Box is 6 fluid ounces, and the Juice Boxes are typically sold in packs of eight.
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`Depending on flavor, a 6-fluid-ounce serving of the Juice Boxes contains between 19g and 21g of free sugar,
`constituting 80% to nearly 100% of each Juice Box’s calories.
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`Reynolds v. The Coca-Cola Co.
`CLASS ACTION COMPLAINT
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`Case 3:23-cv-01446-VC Document 1 Filed 03/28/23 Page 4 of 47
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`Coca-Cola is well aware that consumers prefer healthful foods and are willing to pay more
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`for, or purchase more often, products marketed and labeled as healthy. For instance, a Nielsen Global Health
`& Wellness Survey found that “88% of those polled are willing to pay more for healthier foods.”2
`Coca-Cola has taken advantage of this by marketing the Juice Boxes as healthy options,
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`including by promoting them with health and wellness messages directly on their labeling and packaging.
`During the Class Period, Coca-Cola labeled the Juice Boxes as both “Good for You!” and
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`“Part of a Healthy, Balanced Diet.”
`Coca-Cola also uses images of fresh fruit on the Juice Boxes to further reinforce the perception
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`that the Juice Boxes are healthy.
`Below is a representative example of the Juice Boxes’ packaging sold during the Class Period.
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`These images and statements, however, are false or at least highly misleading because they
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`convey that the Juice Boxes are healthy (beneficial to health) when in reality regularly consuming them is
`unhealthy since it increases risk of disease.
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`2 Gagliardi, N., Consumers Want Healthy Foods—And Will Pay More For Them, FORBES (Feb. 18, 2015)
`(citing Global Health & Wellness Survey, NIELSEN (Jan. 2015)).
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`Reynolds v. The Coca-Cola Co.
`CLASS ACTION COMPLAINT
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`Case 3:23-cv-01446-VC Document 1 Filed 03/28/23 Page 5 of 47
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`II.
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`SCIENTIFIC EVIDENCE DEMONSTRATES THAT CONSUMING JUICE, LIKE COCA-
`COLA’S JUICE BOXES, IS UNHEALTHY
`A. While Consuming Whole Fruit is Beneficial to Health, Processing it into Juice Renders
`it Harmful to Health
`Susan Jebb, Professor of Diet and Population at Cambridge University, has explained that
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`many “people believe fruit juices . . . have about the same effects as eating fruit. Unfortunately, this is wrong
`. . . .”3 This is because processing intact fruit destroys the fruits’ natural food matrix thereby concentrating
`and releasing the fruit’s sugar, which “is absorbed very fast, so by the time it gets to your stomach your body
`doesn’t know whether it’s Coca-Cola or orange juice[.]’” Ms. Jebb has accordingly cautioned consumers,
`“don’t fall for the fruit juice trap and don’t believe the hype that it’s a good addition to a balanced meal.”4
`The food matrix is “the nutrient and non-nutrient components of foods and their molecular
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`relationships, i.e., chemical bonds, to each other.”5 The food matrix may be viewed as a physical domain that
`contains and/or interacts with specific constituents of a food (e.g., a nutrient) providing functionalities and
`behaviors which are different from those exhibited by the components in isolation or a free state. It is, quite
`literally, the physical geometry of the food.6
`The effect of the food matrix (FM-effect) has profound implications in food processing, oral
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`processing, satiation, and satiety, and digestion in the gastrointestinal tract.7
`The effect of the food matrix also explains the counterintuitive reality that consuming two
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`foods with the same chemical composition may lead to significantly different outcomes for health based on
`their chemical structures.
`
`(Oct.
`
`15,
`
`2018),
`
`at
`
`
`3 Don’t Fall
`For Us
`Trap, Apartments
`Juice
`the
`for
`https://www.apartmentsforus.com/dont-fall-for-the-fruit-juice-trap/.
`4 Id.
`5 United
`Department
`States
`https://lod.nal.usda.gov/nalt/17238.
`6 See Aguilera, J., The food matrix: implications in processing, nutrition and health, 59(22) CRIT. REV. FOOD
`SCI. NUTR. 3612 (2019).
`7 See id.
`
`of Agriculture, NAL Agricultural
`
`Thesaurus,
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`at
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`Case 3:23-cv-01446-VC Document 1 Filed 03/28/23 Page 6 of 47
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`25. When fruit is processed into fruit juice, the fruits’ natural food matrix is destroyed. This both
`concentrates and releases the sugar from its natural fiber encasing so that it becomes “free sugar.”8 And
`because of the negative health effects of consuming free sugars, a piece of fruit, while perhaps a healthy food
`choice when it is whole, is transformed into a decidedly unhealthy food once processed into juice.9
`For example, “studies show that eating whole fruit gives you the most of this food group’s
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`potential benefits, like helping to prevent heart disease, stroke and some types of cancer” and “may
`significantly lower your risk of type 2 diabetes . . . . Conversely, drinking fruit juice every day had the
`opposite effect, increasing the chances of diabetes by 21 percent.”10
`
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`8 “Added sugars” include sugars added to foods during processing or preparation, such as brown sugar,
`sucrose, honey, invert sugar, molasses, and fruit juice concentrates, but under some definitions (like the
`FDA’s), do not include naturally-occurring sugars present in intact fruits, vegetables, and dairy products
`and—as relevant here—in juiced or pureed fruits and vegetables. “Free sugars,” on the other hand (for
`example, as used by the World Health Organization (WHO)), definitionally excludes only sugars naturally
`occurring in intact fruits, vegetables, or dairy products, and so includes sugars from juice. Thus, the
`definitional “distinction between added and free sugars is that the latter includes all naturally occurring sugars
`in nonintact (i.e., juiced or pureed) fruit and vegetables.” See Mela, D.J. et al., Perspective: Total, Added, or
`Free? What Kind of Sugars Should We Be Talking About?, 9(2) ADV. NUTR. 63, 63-64 (Mar. 2018) [“Mela,
`Sugar Perspective”]. This is, however, merely semantical. “The existence of these different ways of
`classifying sugars in foods and beverages in authoritative dietary guidance and nutrition communication
`implies that the distinctions are deemed to be physiologically relevant. But physiologic differentiation
`between these classes [of sugars] arise[s] mainly from effects of the [food] matrix in which the sugars are
`found. For example, it has often been shown that the acute metabolic impact is lower and satiety effects
`greater for intact fruit than for the comparable fruit juices, the latter having effects more similar to other
`sugar-sweetened beverages (SSBs).” Id. at 64. Thus, “the term ‘free sugars’ best conveys the nature and
`sources of dietary sugars that are most consistently related to risks of positive energy balance, and that are
`also associated with diabetes and dental caries.” Id. at 67.
`9 See Mela, Sugar Perspective, supra n.8.
`10 McClusky,
`(May 31, 2017),
`J., The Whole Truth About Whole Fruits, WEBMD
`https://www.webmd.com/food-recipes/news/20170531/the-whole-truth-about-whole-fruits.
`See
`also
`Dreher, M.L., Whole Fruits and Fruit Fiber Emerging Health Effects, 12(10) NUTRIENTS 1833, 1833 (Nov.
`2018) (“health benefits [of consuming whole fruits] include: . . . reducing risk of cardiovascular disease, type
`2 diabetes and metabolic syndrome; defending against colorectal and lung cancers”); Muraki, I., et al., Fruit
`consumption and risk of type 2 diabetes: results from three prospective longitudinal cohort studies, 347 BRIT.
`MED. J. f5001 (Aug. 2013) (“Greater consumption of specific whole fruits . . . is significantly associated with
`a lower risk of type 2 diabetes, whereas greater consumption of fruit juice is associated with a higher risk.”).
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`Numerous studies have similarly found that whole fruits have a protective effect regarding
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`diabetes whereas juice consumption not only has no protective effect, but actually increases risk of diabetes.11
`Likewise, while consuming whole fruits is protective and decreases risk of cardiovascular
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`diseases, consuming juice increases risk of cardiovascular diseases12 and all-cause mortality.13
`In addition, “fruit juice increases the risk for type 2 diabetes and obesity . . . , in contrast to
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`the lowered risk with whole fruit” and “research concurs that eating whole fruit is beneficial to health and
`prevents a broad category of disease, while fruit juice may be counterproductive to overall health in some
`categories.”14
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`11 Bazzano, L.A., et al., Intake of fruit, vegetables, and fruit juices and risk of diabetes in women, 31
`DIABETES CARE 1311 (2008) (cohort study of 71,346 women from the Nurses’ Health Study followed for 18
`years showed that those who consumed 2 to 3 apple, grapefruit, and orange juices per day (280-450 calories
`and 75-112.5 grams of sugar) had an 18% greater risk of type 2 diabetes than women who consumed less
`than 1 sugar-sweetened beverage per month); Drouin-Chatier, J., et al., Changes in Consumption of Sugary
`Beverages and Artificially Sweetened Beverages and Subsequent Risk of Type 2 Diabetes: Results From
`Three Large Prospective U.S. Cohorts of Women and Men, 42 DIABETES CARE 2181 (Dec. 2019) (finding
`that increasing sugary beverage intake—which included both sugar-sweetened beverages and fruit juice—
`by half-a-serving per day over a 4-year period was associated with a 16% greater risk of type 2 diabetes);
`Imamura, F., et al., Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit
`juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population
`attributable fraction, 351 BRIT. MED. J. 3576 (2015) (meta-analysis of 17 prospective cohort studies showed
`higher consumption of fruit juice was associated with a 7% greater incidence of type 2 diabetes); WHO urges
`global action to curtail consumption and health impacts of sugary drinks, World Health Organization (Oct.
`11, 2016), https://www.who.int/news/item/11-10-2016-who-urges-global-action-to-curtail-consumption-
`and-health-impacts-of-sugary-drinks (“Consumption of free sugars, including products like sugary drinks, is
`a major factor in the global increase of people suffering from obesity and diabetes[.]”).
`12 Hansen, L., et al., Fruit and vegetable intake and risk of acute coronary syndrome, 104 BRIT. J. NUTR. 248
`(2010) (finding “a tendency towards a lower risk of ACS [acute coronary syndrome] . . . for both men and
`women with higher fruit and vegetable consumption,” but “a higher risk . . . among women with higher fruit
`juice intake”); Pase, M.P., et al., Habitual intake of fruit juice predicts central blood pressure, 84 APPETITE
`658 (2015) (people who consumed juice daily, rather than rarely or occasionally, had significantly higher
`central systolic blood pressure, a risk factor for cardiovascular disease”).
`13 Collin, L.J., et al., Association of Sugary Beverage Consumption With Mortality Risk in US Adults: A
`Secondary Analysis of Data From the REGARDS Study, 2(5) JAMA NETWORK OPEN e193121 (May 2019)
`(cohort study of 13,440 black and white adults 45 years and older, observed for a mean of 6 years, found
`each additional 12-oz serving per day of fruit juice was associated with a 24% higher all-cause mortality
`risk). See also Thomas, L., Differences Between Natural Whole Fruit and Natural Fruit Juice, NEWS
`MEDICAL (Feb. 27, 2019) (“In one study, increased fruit juice consumption in early life led to a higher risk
`of obesity and shorter adult height.”).
`14 Thomas, Differences Between Natural Whole Fruit and Natural Fruit Juice, supra n.13.
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`As Dr. Robert Lustig, a professor emeritus of Pediatrics, Division of Endocrinology at the
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`University of California, San Francisco, explains, when you drink juice instead of eating whole fruit, you no
`longer get the suppression of the insulin response, making juice “as egregious a delivery vehicle for sugar as
`is soda. Studies of juice consumption show increased risk of diabetes and heart disease even after controlling
`for calories, while whole fruit demonstrates protection.”15
`Barry M. Popkin, PhD, a W. R. Kenan Jr. Distinguished Professor in the Department of
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`Nutrition at University of North Carolina, Gillings School of Global Public Health, explains that “as people
`change their drinking habits to avoid carbonated soft drinks, the potential damage from naturally occurring
`fructose in fruit juices and smoothies is being overlooked.” “‘[P]ulped-up smoothies do nothing good for us
`but do give us the same amount of sugar as four to six oranges or a large coke. It is deceiving.’”16
`As demonstrated in more detail below, the scientific evidence demonstrates that consuming
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`fruit juice, like the Juice Boxes, increases risk of numerous diseases.
`Juice Consumption Increases Risk of Cardiovascular Heart Disease
`B.
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`Heart disease is the number one killer in the United States. The scientific literature
`demonstrates that consumption of sugar-containing beverages (SCB), including juices, at amounts typically
`consumed, has deleterious effects on heart health.
`In a study published in January 2020, researchers set out to determine whether consumption
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`of SCBs, including juice, is associated with cardiometabolic risk (CMR) in preschool children. They did so
`using 2007-2018 data from TARGet Kids!, a primary-care, practice-based research network in Canada. After
`controlling for sociodemographic, familial, and child-related covariates, they found higher consumption of
`SCB was significantly associated with elevated CMR scores, including lower HDL “good” cholesterol, and
`higher triglycerides. In addition, when examined separately, juice specifically was significantly associated
`
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`15 Lustig, R.H., MD, MSL, METABOLICAL: THE LURE AND THE LIES OF PROCESSED FOOD, NUTRITION, AND
`MODERN MEDICINE 259-60 (Harper Wave 2021).
`16 Boseley, S., Smoothies and fruit juices are a new risk to health, US scientists warn, THE GUARDIAN (Sept.
`7, 2013) (noting that “researchers from the UK, USA and Singapore found that in large-scale studies
`involving nurses, people who ate whole fruit, especially blueberries, grapes and apples, were less likely to
`get type 2 diabetes . . . but those who drank fruit juice were at increased risk. People who swapped their fruit
`juice for whole fruits three times a week cut their risk by 7%”).
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`Case 3:23-cv-01446-VC Document 1 Filed 03/28/23 Page 9 of 47
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`with lower HDL cholesterol. The researchers stated that their “findings support recommendations to limit
`overall intake of SCB in early childhood, in [an] effort to reduce the potential long-term burden of CMR.”17
`But juice consumption does not just detrimentally affect children. Analyzing data from the
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`Danish Diet, Cancer and Health cohort study, representing 57,053 men and women aged 50 to 64 years old,
`researchers found “a tendency towards a lower risk of ACS [acute coronary syndrome] . . . for both men and
`women with higher [whole] fruit and vegetable consumption,” but “a higher risk . . . among women with
`higher fruit juice intake[.]”18
`In one study, those who consumed juice daily, rather than rarely or occasionally, had
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`significantly higher central systolic blood pressure, a risk factor for cardiovascular disease, even after
`adjusting for age, height, weight, mean arterial pressure, heart rate, and treatment for lipids and
`hypertension.19
`Studies of the cardiovascular effects of added sugar consumption further suggest juice
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`consumption causes increased risk for and contraction of cardiovascular disease, since the free sugars in juice
`act physiologically identically to added sugars, such as those in sugar-sweetened beverages.
`For example, data obtained from NHANES surveys during the periods of 1988-1994, 1999-
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`2004, and 2005-2010—after adjusting for a wide variety of other factors—demonstrate that those who
`consumed 10% - 24.9% of their calories from added sugar had a 30% greater risk of cardiovascular disease
`(CVD) mortality than those who consumed 5% or less of their calories from added sugar. In addition, those
`who consumed 25% or more of their calories from added sugar had an average 275% greater risk of CVD
`mortality than those who consumed less than 5% of calories from added sugar. Similarly, when compared to
`those who consumed approximately 8% of calories from added sugar, participants who consumed
`approximately 17% - 21% (the 4th quintile) of calories from added sugar had a 38% higher risk of CVD
`mortality, while the relative risk was more than double for those who consumed 21% or more of calories
`
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`17 Eny, K.M., et al., Sugar-containing beverage consumption and cardiometabolic risk in preschool children,
`17 PREV. MED. REP. 101054, 101054 (Jan. 14, 2020).
`18 Hansen, L., et al., Fruit and vegetable intake and risk of acute coronary syndrome, 104 BRITISH J. NUTR.
`248, 248 (2010).
`19 Pase, M.P., et al., Habitual intake of fruit juice predicts central blood pressure, 84 APPETITE 658 (2015).
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`from added sugar (the 5th quintile). Thus, “[t]he risk of CVD mortality increased exponentially with
`increasing usual percentage of calories from added sugar,” as demonstrated in the chart below.20
`
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`The NHANES analysis also found “a significant association between sugar-sweetened
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`beverage consumption and risk of CVD mortality,” with an average 29% greater risk of CVD mortality
`“when comparing participants who consumed 7 or more servings/wk (360 mL per serving) with those who
`consumed 1 serving/wk or less . . . .”21 The study concluded that “most US adults consume more added sugar
`than is recommended for a healthy diet. A higher percentage of calories from added sugar is associated with
`significantly increased risk of CVD mortality. In addition, regular consumption of sugar-sweetened
`beverages is associated with elevated CVD mortality.”22
`Data from the Nurses’ Health Study consistently showed that, after adjusting for other
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`unhealthy lifestyle factors, those who consumed two or more sugar-sweetened beverages per day (280
`
`
`20 Yang, Q., et al., Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults, 174(4)
`JAMA INTERN. MED. 516, 519-20 (2014).
`21 Id. at 521.
`22 Id. at 522.
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`calories, or 70 grams of sugar or more) had a 35% greater risk of coronary heart disease compared with
`infrequent consumers.23
`In another prospective cohort study, it was suggested that reducing sugar consumption in
`41.
`liquids is highly recommended to prevent CHD. Consumption of sugary beverages was significantly shown
`to increase risk of CHD, as well as adverse changes in some blood lipids, inflammatory factors, and leptin.24
`Juice consumption is also associated with several key risk factors for heart disease. For
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`example, consumption of sugary beverages like juice has been associated with dyslipidemia,25 obesity,26 and
`increased blood pressure.27
`Juice Consumption Increases Risk of Type 2 Diabetes
`C.
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`Diabetes affects 34.2 million Americans—just over 1 in 10. From 2001 to 2017, the number
`of people under age 20 living with type 1 diabetes increased by 45%, and the number living with type 2
`diabetes grew by 95%.28
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`23 Fung, T.T., et al., Sweetened beverage consumption and risk of coronary heart disease in women, 89 AM.
`J. CLIN. NUTR. 1037 (Feb. 2009).
`24 Koning, L.D., et al., Sweetened Beverage Consumption, Incident Coronary Heart Disease, and Biomarkers
`of Risk in Men, 125 CIRCULATION 1735 (2012).
`25 Elliott, S.S., et al., Fructose, weight gain, and the insulin resistance syndrome, 76(5) AM. J. CLIN. NUTR.
`911 (2002).
`26 Faith, M.S., et al., Fruit Juice Intake Predicts Increased Adiposity Gain in Children From Low-Income
`Families: Weight Status-by-Environment Interaction, 118 PEDIATRICS 2066 (2006) (“Among children who
`were initially either at risk for overweight or overweight, increased fruit juice intake was associated with
`excess adiposity gain, whereas parental offerings of whole fruits were associated with reduced adiposity
`gain.”); Schulze, M.B., et al., Sugar-Sweetened Beverages, Weight Gain, and Incidence of Type 2 Diabetes
`in Young and Middle-Aged Women, 292(8) JAMA 927 (2004) [“Schulze, Diabetes in Young & Middle-Aged
`Women”]; Ludwig, D.S., et al., Relation between consumption of sugar-sweetened drinks and childhood
`obesity: a prospective, observational analysis, 257 LANCET 505 (2001); Dennison, B.A., et al., Excess fruit
`juice consumption by preschool-aged children is associated with short stature and obesity, 99 PEDIATRICS 15
`(1997).
`27 Hoare, E., et al., Sugar- and Intense-Sweetened Drinks in Australia: A Systematic Review on
`Cardiometabolic Risk, 9(10) NUTRIENTS 1075 (2017).
`28 Centers for Disease Control and Prevention, New Research Uncovers Concerning Increases in Youth
`Living with Diabetes in the U.S., (Aug. 24, 2021) at https://www.cdc.gov/media/releases/2021/p0824-youth-
`diabetes.html.
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`10
`Reynolds v. The Coca-Cola Co.
`CLASS ACTION COMPLAINT
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`“Increases in diabetes are always troubling – especially in youth. Rising rates of diabetes,
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`particularly type 2 diabetes, which is preventable, has the potential to create a cascade of poor health
`outcomes,” says Giuseppina Imperatore, MD, PhD, chief of the Surveillance, Epidemiology, Economics, and
`Statistics Branch in the Centers for Disease Control (CDC)’s Division of Diabetes Translation. “Compared
`to people who develop diabetes in adulthood, youth are more likely to develop diabetes complications at an
`earlier age and are at higher risk of premature death.”29
`Diabetes can cause kidney failure, lower-limb amputation, and blindness; doubles the risk of
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`colon and pancreatic cancers; and is strongly associated with coronary artery disease and Alzheimer’s
`disease.30
`In 2010, Harvard researchers performed a meta-analysis of 8 studies concerning sugar-
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`sweetened beverage consumption and risk of type 2 diabetes, involving a total of 310,819 participants. They
`concluded that individuals in the highest quantile of SSB intake had an average 26% greater risk of
`developing type 2 diabetes than those in the lowest quantile.31 Moreover, “larger studies with longer
`durations of follow-up tended to show stronger associations.”32 Thus, the meta-analysis showed “a clear link
`between SSB consumption and risk of . . . type 2 diabetes.”33
`An analysis of data for more than 50,000 women from the Nurses’ Health Study,34 during two
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`4-year periods (1991-1995, and 1995-1999), showed, after adjusting for confounding factors, that women
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`29 Id.
`30 Aranceta Bartrina, J., et al., Association between sucrose intake and cancer: a review of the evidence, 28
`NUTRICIÓN HOSPITALARIA 95 (2013); Garcia-Jimenez, C., A new link between diabetes and cancer:
`enhanced WNT/beta-catenin signaling by high glucose, 52(1) J. MOLECULAR ENDOCRINOLOGY R51 (2014);
`Linden, G.J., All-cause mortality and periodontitis in 60-70-year-old men: a prospective cohort study, 39(1)
`J. CLINICAL PERIODONTAL 940 (Oct. 2012).
`31 Malik, V.S., et al., Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes,
`33(11) DIABETES CARE 2477, 2480 (Nov. 2010) [“Malik, 2010 Meta-Analysis”].
`32 Id. at 2481.
`33 Id.
`34 The Nurses’ Health Study was established at Harvard in 1976, and the Nurses’ Health Study II, in 1989.
`Both are long-term epidemiological studies conducted on women’s health. The study followed 121,700
`women registered nurses since 1976, and 116,000 female nurses since 1989, to assess risk factors for cancer,
`diabetes, and cardiovascular disease. The Nurses’ Health Studies are among the largest investigations into
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`Reynolds v. The Coca-Cola Co.
`CLASS ACTION COMPLAINT
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`who consumed 1 or more sugar-sweetened soft drink per day (i.e., 140-150 calories and 35-37.5 grams of
`sugar), had an 83% greater relative risk of type 2 diabetes compared with those who consumed less than 1
`such beverage per month, and women who consumed 1 or more fruit punch drinks per day had a 100%
`greater relative risk of type 2 diabetes.35
`The result of this analysis shows a statistically significant linear trend with increasing sugar
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`consumption.36
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`A prospective cohort study of more than 43,000 African American women between 1995 and
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`2001 showed that the incidence of type 2 diabetes was higher with higher intake of both sugar-sweetened
`soft drinks and fruit drinks. After adjusting for confounding variables, those who drank 2 or more soft drinks
`per day (i.e., 140-300 calories and 35-75 grams of sugar) showed a 24% greater risk of type 2 diabetes, and
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`risk factors for major chronic disease in women ever conducted. See generally The Nurses’ Health Study, at
`http://www.channing.harvard.edu/nhs.
`35 Schulze, Diabetes in Young & Middle-Aged Women, supra n.26.
`36 Hu, F.B., et al., Sugar-sweetened beverages and risk of obesity and type 2 diabetes: Epidemioligic
`evidence, 100 PHYSIOLOGY & BEHAVIOR 47 (2010).
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`CLASS ACTION COMPLAINT
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`those who drank 2 or more fruit drinks per day showed a 31% greater risk of type 2 diabetes than those who
`drank 1 or less such drinks per month.37
`A large cohort study of 71,346 women from the Nurses’ Health Study followed for 18 years
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`showed that those who consumed 2 to 3 apple, grapefruit, and orange juices per day (280-450 calories and
`75-112.5 grams o