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Proposed Criteria for Selecting the WIC Food Packages A Preliminary Report of the Committee to Review the WIC Food Packages Food and Nutrition Board
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 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. This study was supported by contract number 43-3198-03-0127 between the National Academy of Sciences and the U.S. Department of Agriculture. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the sponsoring agency that provided support for the project. International Standard Book Number: 0-309-0XXXX-X (book) International Standard Book Number: 0-309-0XXXX-X (PDF) Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2004 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
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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. Harvey V. Fineberg 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 chair and vice chair, respectively, of the National Research Council. www.national-academies.org
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COMMITTEE TO REVIEW THE WIC FOOD PACKAGES SUZANNE P. MURPHY, Chair, Cancer Research Center of Hawaii, University of Hawaii, Honolulu BARBARA L. DEVANEY, Mathematica Policy Research, Inc., Princeton, NJ GEORGE M. GRAY, Department of Health Policy and Management, School of Public Health, Harvard University, Boston, MA GAIL G. HARRISON*, Department of Community Health Sciences, School of Public Health, University of California--Los Angeles HELEN H. JENSEN, Department of Economics and Center for Agricultural and Rural Development, College of Agriculture, Iowa State University, Ames LUCIA L. KAISER, Department of Nutrition, College of Agriculture and Environmental Sciences, University of California--Davis JEAN D. KINSEY, Department of Applied Economics and The Food Industry Center, College of Agricultural, Food and Environmental Sciences, University of Minnesota, St. Paul ANGELA M. ODOMS-YOUNG, School of Allied Health Professions, College of Health and Human Sciences, Northern Illinois University, Dekalb KAREN E. PETERSON, Department of Society, Human Development and Health and Department of Nutrition, and Public Health Nutrition Program, School of Public Health, Harvard University, Boston, MA ANNA MARIA SIEGA-RIZ, Department of Maternal and Child Health and Department of Nutrition, Carolina Population Center, and Nutrition Epidemiology Core for the Clinical Nutrition Research Center, School of Public Health, University of North Carolina--Chapel Hill VIRGINIA A. STALLINGS, Nutrition Center, Division of Gastroenterology and Nutrition, Joseph Stokes Jr. Research Institute, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia CAROL WEST SUITOR, Nutrition Consultant, Northfield, VT ______________________________ *Member, Institute of Medicine Staff JANICE RICE OKITA, Senior Program Officer TAZIMA A. DAVIS, Research Associate JON Q. SANDERS, Senior Program Assistant v
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FOOD AND NUTRITION BOARD CATHERINE E. WOTEKI, Chair, Department of Food Science and Human Nutrition, Iowa State University, Ames ROBERT M. RUSSELL, Vice-Chair, U.S. Department of Agriculture's Jean Mayer Human Nutrition Research Center on Aging, Tufts University, Boston, MA LARRY R. BEUCHAT, Center for Food Safety, University of Georgia, Griffin SUSAN FERENC, SAF*Risk, L.C., Madison, WI NANCY F. KREBS, Department of Pediatrics, University of Colorado Health Sciences Center, Denver SHIRIKI KUMANYIKA, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia REYNOLDO MARTORELL, Rollins School of Public Health, Emory University, Atlanta LYNN PARKER, Child Nutrition Programs and Nutrition Policy, Food Research and Action Center, Washington, DC NICHOLAS J. SCHORK, Department of Psychiatry, Polymorphism Research Laboratory, University of California--San Diego JOHN W. SUTTIE, Department of Biochemistry, University of Wisconsin, Madison STEVE L. TAYLOR, Department of Food Science and Technology and Food Processing Center, University of Nebraska--Lincoln BARRY L. ZOUMAS, Department of Agricultural Economics and Rural Sociology, Pennsylvania State University, University Park IOM Council Liaison DONNA E. SHALALA, University of Miami, Florida Staff LINDA D. MEYERS, Director GERALDINE KENNEDO, Administrative Assistant ELIZABETH RIMAUD, Financial Associate vi
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Reviewers 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: Steven A. Abrams, Baylor College of Medicine and Texas Children's Hospital; Lindsay H. Allen, University of California--Davis; Susan S. Baker, Children's Hospital of Buffalo; George H. Beaton, Professor Emeritus, University of Toronto; Mary Kay Fox, Independent Nutrition Consultant, Reading, MA; Philip M. Gleason, Mathematica Policy Research, Inc., Geneva, NY; Geraldine Henchy, Food Research and Action Center, Washington, DC; Anne Looker, National Center for Health Statistics, Centers for Disease Control and Prevention; Edward R. B. McCabe, Mattel Children's Hospital and David Geffen School of Medicine, University of California--Los Angeles; Roy M. Pitkin, Professor Emeritus, University of California--Los Angeles; Kathleen M. Rasmussen, Cornell University. 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 Johanna T. Dwyer, Tufts-New England Medical Center and Office of Dietary Supplements at the National Institutes of Health. Appointed by the National Research Council and the 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. vii
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Contents Executive Summary ES-1 Chapter 1 Introduction and Background 1-1 The WIC Program, 1-1 The WIC Population Has Changed Since the Inception of the WIC Program, 1-4 The Food Supply and Dietary Patterns Have Changed Since the Inception of the WIC Program, 1-6 The Health Risks of the WIC-Eligible Population Have Changed Since the Inception of the WIC Program, 1-7 Dietary Guidance and Recommendations Have Changed Since the Inception of the WIC Program, 1-9 The Committee's Task, 1-10 Chapter 2 Challenges to Selecting an Effective Set of WIC Food Packages 2-1 Introduction, 2-1 Addressing Both Overnutrition and Undernutrition, 2-1 Participant Diversity, 2-1 Employment, 2-3 Food Availability, 2-4 Limitations in Transportation, Storage, or Cooking Facilities, 2-4 Food Safety Considerations, 2-5 Administrative Impacts, 2-5 Incentives, 2-6 Summary, 2-6 Chapter 3 Nutrient Intake of WIC-Eligible Populations 3-1 Introduction, 3-1 Dietary Reference Intakes (IOM, 1997-2004), 3-1 Using the DRI to Assess Nutrient Adequacy, 3-5 Results and Discussion, 3-11 Summary, 3-22 Chapter 4 Food Intake of WIC-Eligible Populations 4-1 Introduction, 4-1 Dietary Intakes of Children Ages 2 through 4 Years and of Women, 4-1 Findings for Young Children and Women, 4-4 Dietary Intakes of Infants and Children Younger Than Two Years, 4-8 Summary, 4-11 viii
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Chapter 5 Nutrition-Related Health Risks and Outcomes of WIC-Eligible Populations 5-1 Introduction, 5-1 Maternal Nutrition-Related Health Risks and Outcomes, 5-1 Nutrition-Related Health Risks and Outcomes in Infants and Children, 5-4 Food Allergies, 5-7 Environmental Risks in the WIC Population, 5-7 Summary, 5-9 Chapter 6 Proposed Approach for Selecting the WIC Food Packages 6-1 Introduction, 6-1 Implications of a Supplemental Food Program, 6-1 Proposed Criteria for the WIC Food Packages, 6-2 Process for Translating the Criteria into Food Packages, 6-4 Evaluating Cost Neutrality, 6-6 Proposed Methods for Evaluating Benefits and Risks of Alternative WIC Food Packages, 6-6 Summary, 6-8 Chapter 7 References 7-1 Appendix A Tables A-1 Appendix B Biographical Sketches of Committee Members B-1 Appendix C Acronyms and Abbreviations C-1 ix
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