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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
Support for this project was provided by the Food and Nutrition Service, U.S. Department of Agriculture. The views presented in this report are those of the Institute of Medicine Committee on Dietary Risk Assessment in the WIC Program and are not necessarily those of the funding agency.
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THE NATIONAL ACADEMIES
National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of Research the National Council.
COMMITTEE ON DIETARY RISK ASSESSMENT IN THE WIC PROGRAM
VIRGINIA A. STALLINGS (chair),
Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, Pennsylvania
TOM BARANOWSKI,
Department of Pediatrics, Baylor College of Medicine, Houston, Texas
RONETTE R. BRIEFEL,
Mathematica Policy Research, Washington, D.C.
YVONNE BRONNER,
Public Health Program, Morgan State University, Baltimore, Maryland
LAURA E. CAULFIELD,
Department of International Health, Johns Hopkins University, Baltimore, Maryland
EZRA C. DAVIDSON, JR.,
Department of Obstetrics and Gynecology, Charles R. Drew University of Medicine and Science, Los Angeles, California
THERESA O. SCHOLL,
Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey, Stratford, New Jersey
CAROL W. SUITOR, Nutrition Consultant,
Northfield, Vermont
ROBERT C. WHITAKER,
Division of General and Community Pediatrics, Children’s Hospital Medical Center, Cincinnati, Ohio
Staff
Romy Gunter-Nathan, Study Director
Kimberly Stitzel, Research Associate
Jaime Lanier, Project Assistant (until May 2001)
Peter Keo, Project Assistant (after May 2001)
FOOD AND NUTRITION BOARD
CUTBERTO GARZA (chair),
Division of Nutritional Science, Cornell University, Ithaca, New York
ALFRED H. MERRILL, JR. (vice chair),
School of Biology, Georgia Institute of Technology, Atlanta
ROBERT M. RUSSELL (vice chair),
Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
VIRGINIA A. STALLINGS (vice chair),
Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, Pennsylvania
LARRY R. BEUCHAT,
Center for Food Safety and Quality Enhancement, University of Georgia, Griffin
BENJAMIN CABALLERO,
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
ROBERT J. COUSINS,
Center for Nutritional Sciences, University of Florida, Gainesville
SHIRIKI KUMANYIKA,
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia
LYNN PARKER,
Child Nutrition Programs and Nutrition Policy, Food Research and Action Center, Washington, D.C.
ROSS L. PRENTICE,
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
A. CATHARINE ROSS,
Department of Nutrition, The Pennsylvania State University, University Park
BARBARA O. SCHNEEMAN,
Department of Nutrition, University of California, Davis
ROBERT E. SMITH,
R.E. Smith Consulting, Inc., Newport, Vermont
STEVE L. TAYLOR,
Food Processing Center, University of Nebraska, Lincoln
BARRY L. ZOUMAS,
Department of Agricultural Economics and Rural Sociology, The Pennsylvania State University, University Park
Staff
ALLISON A. YATES, Director
LINDA D. MEYERS, Deputy Director
GAIL E. SPEARS, Administrative Assistant
GARY WALKER, Financial Associate
Acknowledgments
Sincere appreciation is extended to the many individuals and groups who were instrumental in the development of this report. First and foremost, many thanks are due to the committee members who volunteered countless hours to the research, deliberations, and preparation of the report. Their dedication to this project and to a stringent timeline was commendable, and the basis of our success.
Many individuals volunteered significant time and effort to address and educate our committee members during the workshop and public meeting. Workshop speakers included Jean Anliker, PhD, RD, University of Maryland; Ann Barone, LDN, Rhode Island Department of Health; Gladys Block, PhD, University of California at Berkeley; Graham Colditz, MD, DrPH, Harvard University; Cutberto Garza, MD, PhD, Cornell University; Bob Greenstein, Center on Budget and Policy Priorities, Washington, D.C.; Jill Leppert, LD, RD, North Dakota State Department of Health; Kristin Marcoe, MBA, RD, U.S. Department of Agriculture; Lynn Parker, MS, RD, Food Research and Action Center, Washington, D.C.; Carol Rankin, MS, RD, LD, Mississippi Department of Health; Anna Maria Siega-Riz, PhD, University of North Carolina; Amy Subar, PhD, MPH, RD, National Cancer Institute; Valerie Tarasuk, PhD, University of Toronto; and Amanda Watkins, MD, RD, Arizona Department of Health Services. In addition, two organizations provided oral testimony to the committee during its public meeting: the National Association of WIC Directors and the Food and Nutrition Service, U.S. Department of Agriculture. Sincere thanks and appreciation are also extended to Barbara Ainsworth, PhD, University of South
Carolina, for her valuable assistance as a consultant in the field of physical activity assessment.
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Maxine Hayes, Washington State Department of Health
Jules Hirsch, Rockefeller University
Elvira Jarka, Health Resources and Services Administration
Louise C. Masse, National Cancer Institute
Esther Myers, American Dietetic Association
Valerie Tarasuk, University of Toronto
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Gail Harrison, University of California, Los Angeles. Appointed by the National Research Council and Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
It is apparent that many organizations and individuals from a variety of clinical and scientific backgrounds provided timely and essential support for this project. Yet we would have never succeeded without the efforts, skills, and grace that was provided in large measure by Romy Gunter-Nathan, MPH, RD, our study director for this project; Kimberly Stitzel, MS, RD, research associate; Geraldine Kennedo, project assistant; Jaime Lanier, project assistant; Peter Keo, project assistant; and Allison A. Yates, PhD, RD, director, Food and Nutrition Board, Institute of Medicine.
Last, as chair, I express my sincere appreciation to each member of this committee for their extraordinary commitment to the project and the wonderful