with incomes greater than 130 percent of poverty. Low-income people also are at increased risk for high levels of both morbidity and mortality associated with chronic diseases such as cardiovascular disease, diabetes, obesity, hypertension, and cancer (HHS, 2000).
A previous Institute of Medicine report recommended that failure to meet Dietary Guidelines be used as a criterion to establish dietary risk in WIC (IOM, 1996). Since a criterion consists of an indicator and a cut-off point, this means that the committee had to examine the Dietary Guidelines (USDA/HHS, 2000) for potential indicators and cut-off points. Recognizing that there are 10 guidelines, the committee addressed whether any of the 10 should be excluded from consideration—either because they are covered by other WIC nutritional risk criteria or because the guideline does not include a basis for setting a discrete, measurable cut-off point.
The WIC Policy Memorandum 98-9, Nutrition Risk Criteria (FNB, 1998; see Appendix A), which presents the nutrition risk criteria currently allowed in WIC, those not allowed, and those in need of further review, was examined. Although criterion number 401, failure to meet Dietary Guidelines, is an allowed criterion, it has not been standardized across WIC state agencies. Instead, a state WIC agency may base the criterion used on the definitions currently in use by that agency. (This situation relates to the need for the study by this committee.)
Table 3-1 lists each of the 10 guidelines in abbreviated form, the committee’s decision regarding its relevance to the committee’s work, and the reason, in brief, for that decision. Further details are provided in the text that follows.
The principal advantage of the Dietary Guidelines as a basis for dietary risk criteria is that the guidelines were developed for Americans from all backgrounds as a means to promote health. There are several obstacles to developing criteria for failure to meet Dietary Guidelines:
The Dietary Guidelines are not intended for use for children under age 2 years; this restriction eliminates the use of the Dietary Guidelines for approximately 44 percent of the WIC population (USDA/HHS, 2000).