INDEX

A

AAP. See American Academy of Pediatrics

Acceptable Macronutrient Distribution Ranges (AMDRs), 34, 52–53, 55n, 155, 260n, 267, 290n, 291–292, 297, 313n, 372n

ACNielsen Homescan, 127, 129, 323n, 341n, 343n, 349n, 351n, 354n

ADA. See American Dietetic Association

Added sugars, specifying none, 13

Adequate Intake (AI) values, 34, 49, 266

and mean reported usual intakes of calcium, potassium, and fiber, 50

Adequate nutrients within food energy needs, and consistency of the revised food packages with recommendations from the Dietary Guidel ines for Americans, 153

Administrators in WIC state and local agencies, 22

flexibility and variety from, 171–172

Adolescent and adult women

nutrient intake profiles, 300–301

Food Package V for pregnant and partially breastfeeding women, 300

Food Package VI for non-breastfeeding postpartum women, 300

Food Package VII for fully breastfeeding women, 300–301

overweight and obesity in, 32–33

Advanced Notice of Proposed Rulemaking, 124

AHA. See American Heart Association

AIs. See Adequate Intake values

Alpha-tocopherol (AT), 234n, 244n, 260n, 312n, 364n, 366n

Alpha-tocopherol equivalents (ATEs), 234n, 244n, 260n, 272, 312n, 364n

AMDRs. See Acceptable Macronutrient Distribution Ranges

American Academy of Pediatrics (AAP), 5, 8–9, 16, 62, 68, 70n, 79n, 82, 103, 115, 155, 161n, 171, 323n, 341n, 370n, 374n

Committee on Nutrition, 155

American Dietetic Association (ADA), 68, 155, 157, 161n

American Heart Association (AHA), 55n, 261n, 313n, 341n, 370n, 372n, 374n

Amounts provided by current and revised food packages

compared with amounts suggested for caloric level, 156–157

fruits and vegetables, 156–157

grains, 156–157

meat and alternatives, 156–157

milk and alternatives, 156–157

infant formula provided, 113–114

fully formula-fed infants, 113–114

partially breast-fed infants, 114



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WIC Food Packages: Time for a Change INDEX A AAP. See American Academy of Pediatrics Acceptable Macronutrient Distribution Ranges (AMDRs), 34, 52–53, 55n, 155, 260n, 267, 290n, 291–292, 297, 313n, 372n ACNielsen Homescan, 127, 129, 323n, 341n, 343n, 349n, 351n, 354n ADA. See American Dietetic Association Added sugars, specifying none, 13 Adequate Intake (AI) values, 34, 49, 266 and mean reported usual intakes of calcium, potassium, and fiber, 50 Adequate nutrients within food energy needs, and consistency of the revised food packages with recommendations from the Dietary Guidel ines for Americans, 153 Administrators in WIC state and local agencies, 22 flexibility and variety from, 171–172 Adolescent and adult women nutrient intake profiles, 300–301 Food Package V for pregnant and partially breastfeeding women, 300 Food Package VI for non-breastfeeding postpartum women, 300 Food Package VII for fully breastfeeding women, 300–301 overweight and obesity in, 32–33 Advanced Notice of Proposed Rulemaking, 124 AHA. See American Heart Association AIs. See Adequate Intake values Alpha-tocopherol (AT), 234n, 244n, 260n, 312n, 364n, 366n Alpha-tocopherol equivalents (ATEs), 234n, 244n, 260n, 272, 312n, 364n AMDRs. See Acceptable Macronutrient Distribution Ranges American Academy of Pediatrics (AAP), 5, 8–9, 16, 62, 68, 70n, 79n, 82, 103, 115, 155, 161n, 171, 323n, 341n, 370n, 374n Committee on Nutrition, 155 American Dietetic Association (ADA), 68, 155, 157, 161n American Heart Association (AHA), 55n, 261n, 313n, 341n, 370n, 372n, 374n Amounts provided by current and revised food packages compared with amounts suggested for caloric level, 156–157 fruits and vegetables, 156–157 grains, 156–157 meat and alternatives, 156–157 milk and alternatives, 156–157 infant formula provided, 113–114 fully formula-fed infants, 113–114 partially breast-fed infants, 114

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WIC Food Packages: Time for a Change Analysis samples, 271 breast-fed infants 6-11 months old, 271 non-breastfed WIC infants under 1 year old, 271 non-breastfeeding women 14-44 years old, up to 1 year postpartum, 271 pregnant and lactating women 14-44 years old, 271 WIC children 1-4 years old, 271 Asian Americans, 32 Assessment of nutrient adequacy using the DRIs, 267–270 characteristics of the usual nutrient intake distributions, 268 proportion at risk of excessive intake levels, 269–270 proportion of subgroup with inadequate usual intake, 268–269 AT. See Alpha-tocopherol ATE. See Alpha-tocopherol equivalents B Baby foods, in Food Package II, 7 Background, 19–45 committee’s task, 21 criteria for the redesign of the WIC food packages, 36–45 reasons to consider changes in the WIC food packages, 27–36 Special Supplemental Nutrition Program for Women, Infants, and Children, 22–27 Barriers to overcome, 43 Basic foods candidates for addition to the packages, 82 including foods from each group, allowing some variety and choice, 12 selected substitutions and net cost changes resulting from substitutions, estimated costs of, 140–141 Benefits, 301–302 changes in food packages possibly having multiplier effects, 302 increasing choice possibly increasing consumption of WIC foods, 301 methods for evaluation of, 292–297 Black women, non-Hispanic, 32 BLS. See U.S. Bureau of Labor Statistics Body mass index (BMI), 32n, 33 Body weight management, and consistency of the revised food packages with recommendations from the Dietary Guidelines for Americans, 153 Breast-fed infants 6-12 months old. See also Fully breast-fed infants; Partially breast-fed infants analysis sample, 271 direction of changes in the level of priority nutrients in the revised food packages for, 147 nutrients of concern with regard to inadequate intake by, 252–253 priority nutrients for, 60 usual intake distributions of selected micro-nutrients and electrolytes, 94, 276 Breastfeeding, 69, 83. See also Fully breastfeeding women consistency of the revised food packages for infants and children under 2 years old with established dietary recommendations, 158 possibilities for incentivizing, 383 recommendations for promoting and supporting, 16, 174–175 studies on changes to promote, 168–169 C Calcium, 12, 23, 30–31, 34, 56, 120 adequate intakes and mean reported usual intakes of, 50 health risks from intake of, and lead exposure, 62 increases in dietary oxalates interfering with absorption of, 302 low intake for many women, 49 Calculated costs of representative amounts of foods in revised packages, 125n, 129, 134, 342–349, 342n, 348n children and women, 344–349 infants, 342–343 Calories, reducing, 13 Carbohydrates, and consistency of the revised food packages with recommendations from the Dietary Guidelines for Americans, 154 Cash-value vouchers, 104–105, 165 definitions of, 100 representations of, 100, 359

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WIC Food Packages: Time for a Change Categorical eligibility, required for the WIC program, 22 Caveats and other potential benefits and risks, 301–302 non-quantified benefits and risks, 301–302 CDC. See Centers for Disease Control and Prevention Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration (CFSAN), 225n Center for Nutrition Policy and Promotion, U.S. Department of Agriculture (CNPP), 272 Centers for Disease Control and Prevention, U.S. Department of Health and Human Services (CDC), 128 CFR. See Code of Federal Regulations CFSAN. See Center for Food Safety and Applied Nutrition Changes in nutrient recommendations and dietary guidance, 33–35 new dietary guidance, 34–35 new nutrient recommendations, 33–34 Changes in the food supply and dietary patterns, 29–31 changes in food consumption, 30–31 increased variety in the food supply, 29–30 Changes in the health risks of the WIC-eligible population, 31–33 overweight and obesity in adolescent and adult women, 32–33 overweight in children, 33 Changes in the WIC population, demographic, 27–29 Changes in WIC food packages in age specifications and breastfeeding categories, in Food Packages I and II for infants, 5–6 in allowed foods, possibly leading to decreased consumption of WIC foods, 302 called for by stakeholders, 35–36 need for, 17 in potential intakes paralleling changes in nutrients provided in the packages, 149–151 children 1 year old, 150 children 2-4 years old, 150 formula-fed infants younger than one year old, 150 fully breastfeeding women, 151 non-breastfeeding postpartum women, 151 pregnant women and partially breastfeeding women, 151 to promote breastfeeding, studies on, 168–169 to promote healthier eating patterns and improved nutrient adequacy, studies on, 169–171 in the revised food packages addressing developmental needs of infants and young children, 112–115 addressing obesity concerns, 115–117 discussion of major, 100–120 including fruits and vegetables in the WIC food packages, 101–106 including more whole-grain products, 106 promoting and supporting breastfeeding, 108–112 proposed specifications for foods in the revised food packages, 121–123 providing more flexibility for WIC state agencies and more variety and choice for WIC participants, 117–120 reducing saturated fat and limiting cholesterol for participants 2 years old and older, 107–108 in the types and timing of the availability of complementary foods, 114–115 Cheese, 108 Child Nutrition Act, 20, 356–357 Child Nutrition and WIC Reauthorization Act, 356–357 Children 1 year old changes in potential intakes paralleling changes in nutrients provided in the packages, 150 nutrient intake profiles for, 299 1-2 years old direction of changes in the level of priority nutrients in the revised food packages for, 147 nutrients and ingredients to limit in the diet of, 260 nutrients of concern with regard to excessive intake by, 256–257

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WIC Food Packages: Time for a Change 1-4 years old, considering public comments about food packages for, 81 2-4 years old changes in potential intakes paralleling changes in nutrients provided in the packages, 150 food group priorities for, 65 nutrient intake profiles for, 299–300 2-4 years old and women in the childbearing years, 64–68 children ages 2-4 years, 65 overall, 65, 68 summary, 65, 68 women in the childbearing years, 65 2-5 years old direction of changes in the level of priority nutrients in the revised food packages for, 147 nutrients and ingredients to limit in the diet of, 260 nutrients of concern with regard to excessive intake by, 256–257 comparison of estimated costs of current and revised food packages for, 130–131 defined, 20n estimated program costs for food per participant per month using current packages for, 132–133 estimated program costs for food per participant per month using revised packages for, 136–137 overweight in, 33 revised food package for, 98 revised Food Package III for, 99 WIC food packages for, 97–98 Children and women bases of assumptions used in nutrient and cost analyses of food packages for, 149n, 226n, 236n, 324–341 calculated costs of representative amounts of foods in revised packages for, 344–349 combined fresh and processed option for, 104–105 fresh produce option for, 104 maximum monthly allowances for revised WIC food packages, 90–92 processed fruit and vegetable option for, 104 Cholesterol nutrient analysis of current and revised food packages using NDS-R, 232–233, 302 nutrient analysis of current and revised food packages using SR-17, 242–243 reducing, 13 Chronology of statutes pertaining to the definition of WIC supplemental foods, 22, 95n, 267, 356–357, 373n Child Nutrition Act, 356–357 Child Nutrition and WIC Reauthorization Act, 356–357 CNPP. See Center for Nutrition Policy and Promotion Code of Federal Regulations, U.S. Congress (CFR), 225n Combined fresh and processed option, for children and women, 104–105 Committee on Nutrition, American Academy of Pediatrics, 155 Committee to Review the WIC Food Packages, 21, 23, 120 addressing concerns of WIC program staff and venders, 13–14 as consistent with dietary guidelines, 12–13 criteria of, 11–14 having wide appeal to diverse populations, 13–14 supporting improved nutrient intakes, 11–12 task of, 2 Comparison of cost incentives for breastfeeding, 139–141 comparison of the market (pre-rebate) value of maximum allowances for current and revised food packages for mother/infant pairs, 142–143 Comparison of current and revised food packages, 3, 151, 207–215, 296n, 303–313 for children (Food Package IV), 212 maximum monthly allowances, in Food Package IV for children, 9 estimated costs, 130–131 for children, 130–131 for infants, 130–131 for women, 130–131 for fully breastfeeding women (Food Package VII), 215

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WIC Food Packages: Time for a Change for non-breastfeeding postpartum women (Food Package VI), 214 nutrients and ingredients to limit in the diet, 312–313 nutrients of concern with regard to excessive intake, 150–151, 308–311 nutrients of concern with regard to inadequate intake, 304–307 for older infants (Food Package II), 209–210 for participants with special dietary needs (Food Package III), 211 for pregnant and partially breastfeeding women (Food Package V), 213 with regard to nutrients offered, 255–261 nutrients and ingredients to limit in the diet, 260–261 nutrients of concern with regard to excessive intake, 256–259 nutrients of concern with regard to inadequate intake, 252–255 for young infants (Food Package I), 208 Comparison of current food packages with dietary guidance, 77 dietary guidance related to foods in current WIC food packages, 78–79 Comparison of food items used in nutrient analyses from two databases, 226n, 246–251 fruits and vegetables, 246–249 grains, 248–249 infant foods, 246–247 meat and alternatives, 248–251 milk and alternatives, 248–249 Competent Professional Authorities (CPAs), 26, 92–93, 104, 171–172, 175 defined, 16n, 93n, 167n Complementary foods, 70n, 115 changes in the types and timing of the availability of, 114–115 studies on delay in offering, 169 Concerns about current food packages, 164 from vendors, 164 from WIC local agencies, 164 from WIC state agencies, 164 Consistency of the revised food packages for infants and children under 2 years old with established dietary recommendations, 158–161 breastfeeding, 158 developing healthy eating patterns, 160–161 feeding other foods to infants and young children, 159–160 formula feeding, 158–159 promoting food safety, 161 with recommendations from the Dietary Guidelines for Americans, 153–154 adequate nutrients within food energy needs, 153 body weight management, 153 carbohydrates, 154 fats, 154 food groups encouraged, 153–154 food safety, 154 sodium and potassium, 154 Consumer Price Index, 139 Consumption of WIC foods changes in allowed foods possibly leading to decreased, 302 increasing choice possibly increasing, 301 Container size, addressing, 13 Continuing Survey of Food Intakes by Individuals (CSFII), 49, 50n, 51n, 53n, 55n, 56–57, 67n, 76, 261n, 270–272, 283n, 288n, 290n, 313n limitations in the data set from, 47n Cost calculations, 314–354 assumptions on feeding method, 315–316 bases of assumptions used in nutrient and cost analyses of food packages, 125n, 129, 318–341 calculated costs of representative amounts of foods in revised packages, 125n, 129, 134, 342–349 estimated program costs for food per month, 350–354 possible shifts in participation rates, 316–317 Cost-neutrality, 135 proposed WIC food packages as, 14–15 Costs of substitutions, 135, 139 CPAs. See Competent Professional Authorities Criteria and priorities for revisions, 2–3 criteria for a WIC food package, 3 Phases I and II on developing and using, 4, 21 Criteria for the redesign of the WIC food packages, 36–45 Criterion 1, addressing the dual problems of undernutrition and overnutrition, 37–38 Criterion 2, consistency with the Dietary Guidelines for Americans, 38

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WIC Food Packages: Time for a Change Criterion 3, consistency with recommendations for infants and children younger than age 2 years, 38 Criterion 4, suitability and safety for persons with limited transportation options, storage, and cooking facilities, 38–39 Criterion 5, acceptability, availability, and incentive value, 39–43 Criterion 6, consideration ofadministrative impacts, 43–45 Criterion 1, reducing the prevalence of inadequate and excessive nutrient intakes, 145–151 addressing the dual problems of undernutrition and overnutrition, 37–38 changes in potential intakes paralleling changes in nutrients provided in the packages, 149–151 and evaluating possible food packages, 84 priority nutrients changing in the desired direction in the revised food packages, 146 revised packages, 146–149 Criterion 2, promoting an overall dietary pattern consistent with Dietary Guidelines for Americans, 38, 152–154 amounts provided by current and revised food packages compared with amounts suggested for caloric level, 156–157 consistency of the revised food packages with recommendations from the Dietary Guidelines for Americans, 153–154 and evaluating possible food packages, 84 Criterion 3, promoting an overall diet consistent with Dietary Recommendations for Infants and Children, including support for breastfeeding, 152, 155 consistency of the revised food packages for infants and children under 2 years old with established dietary recommendations, 158–161 consistency with recommendations for infants and children younger than age 2 years, 38 and evaluating possible food packages, 85 Criterion 4, suitability and safety for persons with limited transportation options, storage, and cooking facilities, 38–39, 155, 162 and evaluating possible food packages, 85 tailoring the revised food packages for persons with limited resources, 162 Criterion 5, providing readily acceptable, widely available, and culturally suitable foods and incentives for families to participate, 155–157, 162–163 acceptability, availability, and incentive value, 39–43 food acceptability, 40 food availability, 42–43 foods commonly consumed, 40 incentive value, 43 participant diversity, 41–42 and evaluating possible food packages, 85–86 tailoring revised food packages to be readily acceptable, 163 Criterion 6, considering impacts on vendors and WIC agencies, 43–45, 162, 164–165 concerns about current food packages, 164 and evaluating possible food packages, 86 vendors, 43–44 WIC agencies, 44–45 CSFII. See Continuing Survey of Food Intakes by Individuals Cultural acceptability, 41 Cultural diversity, 117 Culture, defining, 41 Current and revised food packages for mother/infant pairs, comparison of the market (pre-rebate) value of maximum allowances for, 142–143 Current Food Package III, overview of, 98 Current WIC food packages for children, overview of, 97–98 estimated program costs for food per month using, 133n, 138n, 350–351, 352n for infants, overview of, 92–93 maximum monthly allowances, 24–25 for women, overview of, 95

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WIC Food Packages: Time for a Change D Data limitations, 56–57 Data on cost evaluation, 126–128 general considerations, 126 infant formula rebate assumption, 128 numbers of participants, 128 prices, 127–128 Data set, 270–273 analysis sample, 271 nutrients examined, 272–273 Delays, in offering complementary foods, studies on, 169 Delta approach, for evaluating nutritional benefits and risks, 295–296 Demographic changes in the WIC population, 27–29 annual number of participants in the WIC Program, 27 ethnic composition of the WIC population, 29 the WIC population by participant category, 28 Description of the revised food packages, 87–100 Food Package III for children and women with special dietary needs, 98–100 WIC food packages for children, 97–98 WIC food packages for infants, 92–95 WIC food packages for women, 95–97 Devaney, Barbara L., 375 Developing healthy eating patterns, consistency of the revised food packages for infants and children under 2 years old with established dietary recommendations, 160–161 Developmental needs of infants and young children addressing, 112–115 changed from previous food packages, 112–115 amounts of infant formula provided, 113–114 changes in the types and timing of availability of complementary foods, 114–115 DFEs. See Dietary Folate Equivalents DHHS. See U.S. Department of Health and Human Services Dietary changes, possibly leading to undesirable nutrient-nutrient interactions, 302 Dietary fiber. See Fiber Dietary Folate Equivalents (DFEs), 234n, 244n, 260n, 272n, 312, 365n, 366n Dietary guidance for infants and young children, 12 under the age of two years, 69–70 breastfeeding, 69 developing healthy eating patterns, 70 feeding other foods to infants and young children, 69–70 formula feeding, 69 promoting food safety, 70 new, 34–35 proposed WIC food packages as consistent with, 12–13 related to foods in current WIC food packages, 78–79 Dietary Guidelines Advisory Committee, 3, 58, 66n, 85n, 297 Dietary Guidelines for Americans, 3, 9–17, 22, 34–35, 38, 55n, 58, 62–63, 65, 76–77, 84, 98, 101–103, 107, 118, 152–154, 165–166, 170, 175–176, 261n, 290n, 291–292, 297, 313n, 372n addressing container size and food safety concerns, 13 including foods from each basic food group, allowing some variety and choice, 12 including only whole grain products in the breads and cereals, 13 including options that contain no added salt, 13 promoting the consumption of whole fruits and vegetables, 13 providing fruits and vegetables, 13 reducing saturated fat, cholesterol, total fat, and calories, 13 specifying no added sugars, 13 Dietary oxalates, increases in interfering with calcium absorption, 302 Dietary Reference Intakes (DRIs), 33–34, 46, 49, 53n, 58, 148n, 261, 266–267, 280n, 292, 312n, 370n, 373n acceptable macronutrient distribution ranges, 267 adequate intake, 266 estimated average requirement, 266 recommended dietary allowance, 266 tolerable upper intake level, 266 used for assessing intakes of WIC-eligible subgroups, 360–374

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WIC Food Packages: Time for a Change Differences in nutritional needs, in promoting and supporting breastfeeding, 110–111 Dioxin-like compounds (DLC), 62–63 Dioxins, health risks from, 62–63 Direction of changes in the level of priority nutrients in the revised food packages, 147–148 for breastfed infants 6-12 months old, 147 for children 1-2 years old, 147 for children 2-5 years old, 147 for fully breastfeeding women, 148 for non-breastfed infants younger than 1 year, 147 for non-breastfeeding postpartum women, 148 pregnant and partially breastfeeding women, 147 Diverse populations, 117 having wide appeal to, 13–14 DLC. See Dioxin-like compounds Dose-response assessment, 293–294 Dried fruit, 115 DRIs. See Dietary Reference Intakes Dry beans or peas, in Food Package IV for children, 11 E EARs. See Estimated Average Requirements Easy Reference Guide to substitutions for various volumes of formula concentrate, 88n, 93–94, 113n, 236n, 262–264 formula-fed infants, 262–263 partially breastfed infants, 262–263 EBTs. See Electronic benefit transfers Economic Research Service, U.S. Department of Agriculture (ERS), 127, 131n, 133n, 138n, 141n, 143n, 323n, 341n, 343n, 349n Economical packaging, 16 Education. See Nutrition education EERs. See Estimated Energy Requirements Eggs, 30, 108 in Food Package IV for children, 9 price data on, 127 Electronic benefit transfers (EBTs), 44, 100, 172 Elements DRIs used for assessing intakes of, 360–363 nutrient analysis of current and revised food packages using NDS-R, 101n, 110, 226–227 nutrient analysis of current and revised food packages using SR-17, 101n, 236–237 Eligibility. See Participants in the WIC Program EPA. See U.S. Environmental Protection Agency ERS. See Economic Research Service Estimated adequacy of micronutrient usual intakes, 47–48 estimated prevalence of inadequacy of micronutrients and protein, 48–49 using usual intakes for children and women, 49 using usual intakes for infants, 48 Estimated Average Requirements (EARs), 34, 47, 50n, 260n, 266, 268, 273, 282n, 312n, 370n Estimated Energy Requirements (EERs), 51–52, 113, 260n, 261n, 267–269, 370n reported usual food energy intakes and, 51 Estimated program costs for food, 129–131 comparison of estimated costs of current and revised food packages, 130–131 Estimated program costs for food per month, 15, 350–354 selected substitutions and net cost changes resulting from substitutions, 140–141 using current packages, 133n, 138n, 350–351, 352n using revised packages, 352–354 Estimated program costs for food per month per participant using current packages, 132–133 for children, 132–133 for infants, 132–133 for women, 132–133 using revised packages, 136–138 for children, 136–137 for infants, 136–137 for women, 136–137

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WIC Food Packages: Time for a Change Estimates of requirements, 57–58 vitamin E, 58 Estimates of upper levels, 58–59 vitamin A, 58–59 zinc, 58–59 Ethnic composition of the WIC population, marked demographic changes in, 29 Evaluation of cost, 124–144 comparing cost incentives for breastfeeding, 139–141 methods, 126–131 overview, 125–126 projecting the effects of changes in infant formula and milk prices, 142–144 results and discussion, 131, 134–139 of the revised packages, 86 summary, 144 Evaluation of nutritional benefits and risks, 292–297 the delta approach, 295–296 nutrient intake, 294–295 the proportional approach, 296–297 Evaluation of possible food packages, 83–86 Criterion 1, addressing the dual problems of undernutrition and overnutrition, 84 Criterion 2, consistency with the Dietary Guidelines for Americans, 84 Criterion 3, consistency with recommendations for infants and children younger than age 2 years, 85 Criterion 4, suitability and safety for persons with limited transportation options, storage, and cooking facilities, 85 Criterion 5, acceptability, availability, and incentive value, 85–86 Criterion 6, consideration of administrative impacts, 86 Evaluation of potential benefits and risks of the revised food packages, 291–313 application of methods, 297–301 caveats and other potential benefits and risks, 301–302 comparison of current and revised food packages, 151, 296n, 303–313 methods for evaluating nutritional benefits and risks, 292–297 summary, 303 Excessive intake levels, 53–56 nutrients of concern with regard to, 150–151, 308–311 proportion at risk of, 269–270 providing less of nutrients with, 148–149 reported usual intakes above the Tolerable Upper Intake Level and dietary guidance, 54–55 Exposure assessment, 293 F Factor for days per month, 113n Farmers Market Nutrition Program, 172 Fat-reduced milk and milk products, 13 Fat-soluble vitamins nutrient analysis of current and revised food packages using NDS-R, 150, 228–229 nutrient analysis of current and revised food packages using USDA Nutrient Database for Standard Reference (SR-17), 238–239 Fats and consistency of the revised food packages with recommendations from the Dietary Guidelines for Americans, 154 DRIs used for assessing intakes of selected, 372–374 nutrient analysis of current and revised food packages using NDS-R, 234–235 nutrient analysis of current and revised food packages using SR-17, 244–245 FDA. See Food and Drug Administration Feeding Infants and Toddlers Study (FITS), 68, 315 Feeding infants and young children and nutrition education, 176 other foods, 69–70 consistency of the revised food packages for infants and children under 2 years old with established dietary recommendations, 159–160 Feeding method assumptions, 315–316 for infants in the WIC program, 315–316 for women in the WIC program, 316

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WIC Food Packages: Time for a Change Fiber, 51, 56, 60, 64, 106 adequate intakes and mean reported usual intakes of, 50 AIs for children, 58 increases in interfering with mineral absorption, 302 nutrient analysis of current and revised food packages using NDS-R, 232–233, 302 nutrient analysis of current and revised food packages using SR-17, 242–243 First month after birth, revised Food Package I for, 93 FITS. See Feeding Infants and Toddlers Study Flexibility and variety in revising the WIC food packages, 16, 171–172 administrators in WIC state and local agencies, 22, 171–172 Food and Nutrition Service, 171 need for, 74–76 recommendations for, 16, 171–172 Flexibility for WIC state agencies changed from previous food packages, 117–120 fruits and vegetables, 117–119 milk products, 119–120 providing more, 117–120 FNB. See Food and Nutrition Board, Institute of Medicine FNDDS. See Food and Nutrient Database for Dietary Studies FNS. See Food and Nutrition Service Folate, 48. See also Dietary Folate Equivalents and birth defects, 61 as folic acid, 273 Food acceptability, 40 Food and Drug Administration, U.S. Department of Health and Human Services (FDA), 63, 96, 123n, 225n Standards of Identity, 225n Food and Nutrient Database for Dietary Studies (FNDDS), 272 Food and Nutrition Board, Institute of Medicine, The National Academies (FNB), 21 Food and Nutrition Service, U.S. Department of Agriculture (FNS), 2, 16, 21, 23, 26, 42, 128, 131, 136n, 167, 171, 175, 177, 235n, 341n, 352n flexibility and variety, 171 special recommendation on vitamin D supplementation, 171 Food availability, 42–43 Food consumption, changes in, 30–31 Food energy needs, adequate nutrients within, and consistency of the revised food packages with recommendations from the Dietary Guidelines for Americans, 153 Food groups and consistency of the revised food packages with recommendations from the Dietary Guidelines for Americans, encouraging, 153–154 priorities for the WIC food packages, 63–71, 76 children ages 2-4 years and women in the childbearing years, 64–68 low-income children 2-4 years old, and women, 64 low-income children younger than 2 years old, 68–71 mean numbers of servings from five basic food groups consumed by selected age groups, 66–67 nutrient and food group priorities for revision of the WIC food packages, 72–73 in for proposed Food Package II for infants ages 6 months to 1 year, 7 Food Guide, USDA, 118 Food instruments cash-value voucher, 100 definitions of, 100 standard WIC food instrument, 100 workable procedures for, 172–173 Food Package Advisory Panel, 23 Food package costs, estimating, 129 Food Package I for young infants, 5–7, 26, 93–94, 98, 149n, 168, 208, 298–299 for 1-3 month olds, 93–94 at 4 months old, 94 for the first month after birth, 93 fully formula-fed infants, 208 partially breastfed infants, 208 participant eligibility, 208 proposed, 6–7 fully formula-fed infants, 6 partially breast-fed infants, 6

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WIC Food Packages: Time for a Change Food Package II for older infants, 5, 7–8, 16, 26, 94–95, 98–99, 103, 113, 115, 149n, 161n, 209–210, 235n, 298–299 at 6 months old, 94 baby foods, 7 formula, 7 fully breast-fed infants, 209 fully formula-fed infants, 209–210 juice, 8 maximum monthly allowances for proposed Food Package II for infants ages 6 months to 1 year, 7 partially breast-fed infants, 209 participant eligibility, 210 Food Package III for individuals with special dietary needs, 8, 26, 81, 88n, 98–100, 130, 134, 154n, 211 current Food Package III, 98 participant eligibility, 211 revised Food Package III, 98–100 Food Package IV for children, 8–9, 11, 99, 150, 212, 299 comparison of the current and proposed food package for children, maximum monthly allowances, 9 dry beans or peas, 11 eggs, 9 fruits and vegetables, 9 juice, 8 milk and milk alternatives, 9 participant eligibility, 212 whole grains, 11 Food Package V for pregnant and partially breastfeeding women, 5, 6n, 24n, 80, 111, 151, 213 and nutrient intake profiles for adolescent and adult women, 300 participant eligibility, 213 Food Package VI for non-breastfeeding postpartum women, 6n, 151, 214 and nutrient intake profiles for adolescent and adult women, 300 participant eligibility, 214 Food Package VII for fully breastfeeding women, 24n, 43, 90n, 111, 175, 215 and nutrient intake profiles for adolescent and adult women, 300–301 participant eligibility, 215 Food packages as supplementary foods, 81 types of, 82 Food Packages I and II for infants, 5–8 change in age specifications and breastfeeding categories, 5–6 Food Packages V, VI, and VII for women, 11 proposed food packages for women, maximum monthly allowances, 10 Food safety, 39 addressing concerns, 13 and consistency of the revised food packages with recommendations from the Dietary Guidelines for Americans, 154 promoting, 70 Food Stamp program, 22 The food supply and dietary patterns, changes in, 29–31 increased variety in, 29–30 Food Surveys Research Group (FSRG), 313n Foods for addition to the packages basic foods, 82 food packages as supplementary foods, 81 fruits and vegetables, 82 identifying candidate, 81–83 milk and milk products, 83 supporting and promoting breastfeeding, 83 types of food packages, 82 whole grains, 83 commonly consumed, 40 in the current WIC packages to be deleted or reduced in the revised food packages, 82 foods in the current WIC packages to be deleted or reduced in the revised food packages, 82 identifying, 81 and nutrition education, 176 Formula. See Infant formula Formula-fed infants. See also Fully formula-fed infants Easy Reference Guide to substitutions for various volumes of formula concentrate, 262–263

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WIC Food Packages: Time for a Change usual intake distributions of selected micronutrients and electrolytes, 49n, 282–283 changes in potential intakes paralleling changes in nutrients provided in the packages, 151 direction of changes in the level of priority nutrients in the revised food packages for, 148 Non-breastfeeding women 14-44 years old, up to 1 year postpartum, analysis sample, 271 Non-Hispanic black women, 32–33 Non-Hispanic white women, 32 Non-quantified benefits and risks, 301–302 benefits, 301–302 risks, 302 NRC. See National Research Council Nutrient adequacy, studies on changes to promote improved, 169–171 Nutrient analysis of current and revised food packages, 95n, 149n, 226–237, 228n, 230n, 232n, 234n, 341n using NDS-R, 226–235 elements, 101n, 110, 226–227 fat-soluble vitamins, 150, 228–229 fats, 234–235 macronutrients, fiber, phytate, and cholesterol, 232–233, 302 water-soluble vitamins, 230–231 using SR-17, 95n, 145n, 236–245, 322n, 340n elements, 101n, 236–237 fat-soluble vitamins, 238–239 fats, 244–245 macronutrients, fiber, phytate, and cholesterol, 242–243 water-soluble vitamins, 240–241 Nutrient and cost analyses of food packages assumptions, 125n, 129, 318–341 for children and women, 149n, 226n, 236n, 324–341 for infants, 138n, 315n, 318–323 Nutrient and food group priorities for revision of the WIC food packages, 72–73 Nutrient Data Laboratory, U.S. Department of Agriculture (NDL), 250n Nutrient Data System for Research (NDSR), 83, 234n, 235n, 244n, 250n, 261n, 322n, 340n Nutrient Database for Standard Reference, U.S. Department of Agriculture (SR17), 83, 234n, 244n, 245n, 250n, 322n Nutrient intake for evaluating nutritional benefits and risks, 294–295 profiles, 298–301 for adolescent and adult women, 300–301 for children 1 year old, 299 for children 2-4 years old, 299–300 for formula-fed infants younger than 1 year old, 298–299 of WIC subgroups, 265–290 data set, 270–273 Dietary Reference Intakes, 266–267 using the DRIs to assess nutrient adequacy, 267–270 usual intake distributions of selected macronutrients (cholesterol and fiber), 54n, 284–288 usual intake distributions of selected micronutrients and electrolytes, 54n, 274–283 usual intakes and percentages with reported usual intakes of macronutrients and added sugars outside dietary guidance, 289–290 Nutrient-nutrient interactions, dietary changes possibly leading to undesirable, 302 Nutrient priorities for the WIC food packages, 46–60 because of excessive intakes, 77 because of inadequate intakes, 76–77 calcium, potassium, and fiber usual intakes, 48–51 data limitations, 56–57 discussion of results, 56–59 estimated adequacy of micronutrient usual intakes, 47–48 estimates of requirements, 57–58 estimates of upper levels, 58–59 excessive intake levels, 53–56 priority nutrients, 59–60 usual food energy intakes, 51–52 usual intakes of macronutrients and added sugars, 52–53 Nutrient profiles of current and revised food packages, 146, 216–264

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WIC Food Packages: Time for a Change comparison of current and revised food packages with regard to nutrients offered, 255–261 comparison of food items used in nutrient analyses from two databases, 226n, 246–251 nutrient analysis of current and revised food packages, 95n, 149n, 226–237, 228n, 230n, 232n, 234n, 341n specifications for foods in the revised food packages, 90n, 92n, 97, 101, 106, 123n, 177, 218–225, 323n substitutions for various volumes of formula concentrate Easy Reference Guide, 88n, 93–94, 113n, 236n, 262–264 Nutrient recommendations and dietary guidance, changes in, 33–35 new, 33–34 Nutrients. See also Target nutrients target, 22–23 Nutrients and ingredients to limit in the diet, 260–261 children 1-2 years old, 260 children 2-5 years old, 260 comparison of current and revised food packages, 312–313 comparison of current and revised food packages with regard to, 260–261 fully breast-fed infants 6-12 months old, 260 fully formula-fed infants 6-12 months old, 260 lactating women 14-44 years old, 260 non-breastfeeding postpartum women 14-44 years old, 260 pregnant and lactating women 14-44 years old, 260 Nutrients examined, 272–273 folate as folic acid, 273 folate in Dietary Folate Equivalents, 272 niacin, 272 vitamin E, 272 Nutrients of concern providing greater amounts of, 146–148 with regard to excessive intake, 256–259 children 1-2 years old, 256–257 children 2-5 years old, 256–257 comparison of current and revised food packages, 150–151, 308–311 comparison of current and revised food packages with regard to, 256–259 fully formula-fed infants 0-4 months old, 256–257 fully formula-fed infants 4-6 months old, 256–257 fully formula-fed infants 6-12 months old, 256–257 lactating women 14-44 years old, 258–259 non-breastfeeding postpartum women 14-44 years old, 256–257 pregnant and lactating women 14-44 years old, 256–257 with regard to inadequate intake, 252–255 breast-fed infants 6-12 months old, 252–253 comparison of current and revised food packages, 252–255, 304–307 lactating women 14-44 years old, 254–255 non-breastfeeding postpartum women 14-44 years old, 252–255 pregnant and lactating women 14-44 years old, 252–253 WIC children 1-2 years old, 252–253 WIC children 2-5 years old, 252–253 Nutrition Coordinating Center, University of Minnesota (NCC), 234n, 245n, 250n, 261n, 322n, 340n Nutrition Data System for Research software, 234n Nutrition education, 16–17, 175–177 feeding infants and young children, 176 foods, 176 handling food in the home, 176 recommendations for, 16–17, 175–177 shopping, 176 Nutrition-related health priorities for the WIC food packages, 60–63 folate and birth defects, 61 iron-deficiency anemia, 61 other nutrition-related health risks, 62–63 overweight and obesity, 60 summary of nutrition-related health priorities, 63 summary of nutrition-related health risks, 64

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WIC Food Packages: Time for a Change Nutrition-related health risks, 22, 62–63 calcium intake and lead exposure, 62 dioxins, 62–63 methylmercury, 63 vitamin D and bone health, 62 zinc and breast-fed infants 6 through 11 months, 62 NWA. See National WIC Association O Obesity concerns, 60 addressing, changed from previous food packages, 115–117 in adolescent and adult women, 32–33 Class 3, 33 Odoms-Young, Angela M., 378–379 Overweight, 60 in adolescent and adult women, 32–33 in children, 33 P Packaging economical, 16 re-sealable, 16 Partially breast-fed infants, 208, 209 amounts of infant formula provided to, 114 Easy Reference Guide to substitutions for various volumes of formula concentrate, 262–263 Food Package I for, 6 Participants in the WIC Program diversity of, 41–42 eligibility of for children (Food Package IV), 212 for fully breastfeeding women (Food Package VII), 215 for non-breastfeeding postpartum women (Food Package VI), 214 for older infants (Food Package II), 210 for participants with special dietary needs (Food Package III), 211 for pregnant and partially breastfeeding women (Food Package V), 213 for young infants (Food Package I), 208 marked changes in annual number of, 27 marked demographic changes in the WIC population by category, 28 numbers of, 128 Participation rates, possible shifts in, 316–317 Pediatric Nutrition Surveillance System, 60 Pennsylvania State University, 23 Peterson, Karen E., 379 Phases I and II, on developing and using criteria, 4, 21 Physical Activity Level, 51n Phytate nutrient analysis of current and revised food packages using NDS-R, 232–233, 302 nutrient analysis of current and revised food packages using SR-17, 242–243 Policy change, basis for minimizing early supplementation, 111–112 Postpartum, defined, 20n Potassium, 12, 51, 56, 60, 102 adequate intakes and mean reported usual intakes of, 50 and consistency of the revised food packages with recommendations from the Dietary Guidelines for Americans, 154 Pregnancy, defined, 97 Pregnant, lactating, and non-breastfeeding post partum women, priority nutrients for, 60 Pregnant or lactating adolescent and adult women analysis sample, 271 nutrients and ingredients to limit in the diet of, 260 nutrients of concern with regard to excessive intake by, 256–257 nutrients of concern with regard to inadequate intake by, 252–253 usual intake distributions of selected macronutrients (cholesterol and fiber), 49n, 287 usual intake distributions of selected micronutrients and electrolytes, 49n, 280–281 Pregnant women and partially breastfeeding women, changes in potential intakes paralleling changes in nutrients provided in the packages, 151

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WIC Food Packages: Time for a Change Preliminary Open Session, 172, 382 Prescription rate, defined, 126n Price data, 127–128 for eggs, 127 for fruits and vegetables, 127 for infant formula, 127 for other groceries, 127–128 Priority food groups, 76–77 Priority nutrients, 59–60 breast-fed infants 6-11 months, 60 changing in the desired direction in the revised food packages, 146 nutrient priorities because of excessive intakes, 77 nutrient priorities because of inadequate intakes, 76–77 pregnant, lactating, and non-breastfeeding post partum women, 60 WIC children 1-4 years old, 60 WIC infants under 1 year old, non-breastfed, 59 Private-label brands, 30 Process used for revising the WIC food packages, 74–86 comparing current food packages with dietary guidance, 77 considering public comments, 77–81 evaluating possible food packages, 83–86 evaluating the cost of the revised packages, 86 identifying candidate foods for addition to the packages, 81–83 identifying foods that could be deleted or reduced in quantity, 81 need for flexibility, 74–76 Phase I, developing criteria, 4, 75 Phase II, using criteria, 4, 75 priority food groups and nutrients, 76–77 summary, 86 Processed fruit and vegetable option, for children and women, 104 Product availability, recommendations for, 177, 179 Program costs for food estimating, 129–131 per participant per month using current packages, estimated, 132–133 using revised packages, estimated, 136–138 Projections, of the effects of changes in infant formula and milk prices, 142–144 Promoting and supporting breastfeeding, 108–112 changed from previous food packages, 108–112 differences in nutritional needs, 110–111 market value of the packages for the mother/infant pair, 109–110 minimizing early supplementation, 111–112 recommended studies, 112 Proportional approach, for evaluating nutritional benefits and risks, 296–297 Proposed Criteria for Selecting the WIC Food Packages: A Preliminary report of the Committee to Review the WIC Food Packages, 21, 36 Proposed food packages for women, maximum monthly allowances, in Food Packages V, VI, and VII for women, 10 Proposed policy change related to initial food package options, for mother/infant pairs after delivery, minimizing early supplementation, 111 Proposed specifications for foods in the revised food packages, 121–123 changed from previous food packages, 121–123 fruits and vegetables, 121 grains, 122–123 infant foods, 121 meat and alternatives, 123 milk and alternatives, 122 Proposed WIC food packages, 3–11 as cost-neutral, 14–15 Food Package I, 6–7 Food Package II, 7–8 Food Package III for those with special dietary needs, 8 Food Package IV for children, 8–9, 11 Food Packages I and II for infants, 5–8 Food Packages V, VI, and VII for women, 11 in line with the committee’s criteria, 11–14 process for revising the WIC food package, 4

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WIC Food Packages: Time for a Change Protein, 47 high-quality, 23 Public comments, 77–81 about food packages for children ages 1-4 years, 81 about food packages for those with special dietary needs, 81 about infants’ food packages, 80 about women’s food packages, 80 Pyramid Serving Data, 64 Q Quantity-denominated vouchers, 165 R RACC. See Reference amounts customarily consumed per eating occasion RAEs. See Retinol Activity Equivalents RDAs. See Recommended Dietary Allowances Re-sealable packaging, 16 Reasons to consider changes in the WIC food packages, 27–36 changes called for by stakeholders, 35–36 changes in nutrient recommendations and dietary guidance, 33–35 changes in the food supply and dietary patterns, 29–31 changes in the health risks of the WIC-eligible population, 31–33 marked demographic changes in the WIC population, 27–29 Rebate assumption, for infant formula, 128 Recognized Medical Authority (RMA), 98n Recommendations, 103–105 combined fresh and processed option for children and women, 104–105 fresh produce option for children and women, 104 processed fruit and vegetable option for children and women, 104 Recommendations for implementation and evaluation of the revised WIC food packages, 15–17, 166–179 breastfeeding promotion and support, 16, 174–175 flexibility and variety, 16, 171–172 nutrition education, 16–17, 175–177 product availability, 177, 179 studies prior to implementation of the revised packages, 16 summary, 179 workable procedures, 16, 172–174 Recommended Dietary Allowances (RDAs), 33–34, 58–59, 260n, 266, 299, 363n, 366n, 370n Redemption rate, defined, 126n Reduced-fat, defined, 107n Reducing saturated fat and limiting cholesterol for participants 2 years old and older, changed from previous food packages, 107–108 Reference amounts customarily consumed per eating occasion (RACC), 225n Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, 38 Representations of WIC food instruments, 266, 358–359 cash-value, 100, 359 standard, 100, 358 Requirements for WIC program, 22 categorical eligibility, 22 income eligibility, 22 nutritional risk, 22 Retinol activity equivalent (RAE), 234n, 244n, 260n, 282n, 312n, 346n Revised Food Package I, for 1-3 month olds, 93–94 Revised Food Package III, 98–100 for children, 99 for infants, 99 for women, 99–100 The revised food packages, 87–123, 146–149 description of, 87–100 discussion of major changes, 100–120 estimated program costs for food per month using, 352–354 Food Package III for children and women with special dietary needs, 98–100 for infants, 93–95 Food Package I, 93–94 Food Package II, 94–95 maximum monthly allowances, 88–92 for children and women, 90–92 for infants, 88–89 meeting the criteria specified, 145–165 Criterion 1, reducing the prevalence of inadequate and excessive nutrient intakes, 145–151

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WIC Food Packages: Time for a Change Criterion 2, promoting an overall dietary pattern consistent with Dietary Guidelines for Americans, 152–154 Criterion 3, promoting an overall diet consistent with Dietary Recommendations for Infants and Children, including support for breastfeeding, 152, 155 Criterion 4, foods in package available in forms suitable for low-income persons with limited transportation, storage, and cooking facilities, 155, 162 Criterion 5, providing readily acceptable, widely available, and culturally suitable foods and incentives for families to participate, 155–157, 162–163 Criterion 6, considering impacts on vendors and WIC agencies, 162, 164–165 summary, 165 providing greater amounts of nutrients of concern, 146–148 providing greater amounts of nutrients with inadequate intake, 146–148 providing less of nutrients with excessive intake, 148–149 summary, 120 WIC food packages for children, 97–98 WIC food packages for infants, 92–95 WIC food packages for women, 95–97 for women, 96–97 Risks, 302 changes in allowed foods possibly leading to decreased consumption of WIC foods, 302 characterizing, 293–294 dietary changes possibly leading to undesirable nutrient-nutrient interactions, 302 methods for evaluation of, 292–297 RMA. See Recognized Medical Authority S Salt, including options that contain no added, 13, 17 Saturated fat, reducing, 13 Select Committee on Nutrition and Human Needs, U.S. Senate, 34 Shopping, and nutrition education, 176 Siega-Riz, Anna Maria, 379–380 SKU. See Stock-keeping unit Socioeconomic status, 33 Sodium, 53, 56, 101n and consistency of the revised food packages with recommendations from the Dietary Guidelines for Americans, 154 reducing, 16 Soy beverage, 119 Special dietary needs, 26 considering public comments about food packages for those with, 81 Food Package III for children and women with, 98–100 Special recommendation on vitamin D supplementation, from the FNS, 171 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), 1, 19, 22–27 requirements for WIC program, 22 supplemental foods and target nutrients, 22–23 WIC food packages, 23, 26–27 Specialty foods, in for proposed Food Package II for infants ages 6 months to 1 year, 7 Specifications for foods in the revised food packages, 90n, 92n, 97, 101, 106, 123n, 177, 218–225, 323n additional foods for Food Package III, 224 fruits and vegetables, 218–219 grains, 222–223 infant foods, 218–219 meat and alternatives, 223–224 milk and alternatives, 220–222 SR-17. See Nutrient Database for Standard Reference Stakeholders, changes called for by, 35–36 Stallings, Virginia A., 380 Standard Reference 17 (SR-17). See Nutrient Database for Standard Reference Standard WIC food instruments definitions of, 100 representations of, 100, 358 Standards of Identity, 225n

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WIC Food Packages: Time for a Change State health departments, increasing frequency of inspection by, 44 State WIC associations, 35 Statutes pertaining to the definition of WIC supplemental foods, 22, 95n, 267, 356–357, 373n Child Nutrition Act, 356–357 Child Nutrition and WIC Reauthorization Act, 356–357 Stock-keeping unit (SKU), 30 Store-brand products, 30 Studies recommended in promoting and supporting breastfeeding, 112 Studies related to implementation and its effects, 167–171 changes to promote breastfeeding, 168–169 changes to promote healthier eating patterns and improved nutrient adequacy, 169–171 delay in offering complementary foods, 169 prior to implementation of the revised packages, recommendations for, 16 Substitutions costs of, 135, 139 for powdered formula, 113n for various volumes of formula concentrate, ‘Easy Reference Guide,’ 88n, 93–94, 113n, 236n, 262–264 formula-fed infants, 262–263 partially breast-fed infants, 262–263 Sugars, specifying no added, 13 Suitor, Carol West, 380–381 Supplemental Children’s Survey, 270 Supplemental foods, 22–23, 356–357 Supporting breastfeeding. See Breastfeeding; Promoting and supporting breastfeeding Surgeon General’s Report on Health Promotion and Disease Prevention, 35 T Tailoring the revised food packages to be readily acceptable, 163 for persons with limited resources, 162 Target nutrients, 22–23 Temporary Assistance for Needy Families program, 22 Thiamin, 48 Tolerable Upper Intake Levels (ULs), 12, 34, 47, 55, 58–59, 72n, 149, 260n, 266, 269–270, 282n, 298–299, 312n, 362n, 363n, 366n, 374n and dietary guidance, reported usual intakes above, 54–55 Total fat, reducing, 13 Trans fatty acids, 73n, 76, 235n, 245n, 261n, 373n U ULs. See Tolerable Upper Intake Levels (ULs) Undesirable nutrient-nutrient interactions dietary changes possibly leading to, 302 increases in dietary fiber interfering with mineral absorption, 302 increases in dietary oxalates interfering with calcium absorption, 302 University of Minnesota, 83 U.S. Bureau of Labor Statistics (BLS), 29, 127, 131n, 341n, 349n, 351n, 354n Consumer Price Index, 139 U.S. Department of Agriculture (USDA), 2, 21, 23, 35, 64–65, 77, 118, 123n, 137n, 225n, 383 Nutrient Database for Standard Reference (SR-17), nutrient analysis of current and revised food packages using, 95n, 145n, 236–245, 322n, 340n Standard Reference Database, 83 U.S. Department of Health and Human Services (DHHS), 35, 225n U.S. Environmental Protection Agency (EPA), 63, 97, 123n, 225n U.S. General Accounting Office (now U.S. Government Accountability Office) (GAO), 177 U.S. Senate, Select Committee on Nutrition and Human Needs, 34 USDA. See U.S. Department of Agriculture Usual food energy intakes, 51–52 reported usual food energy intakes and estimated energy requirements, 51 Usual intake distributions characteristics of nutrient, 268 of selected macronutrients and added sugars, 52–53 outside dietary guidance, 53, 289–290

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WIC Food Packages: Time for a Change of selected macronutrients (cholesterol and fiber), 54n, 284–288 non-breastfed WIC infants 0-3 months old, 284 non-breastfed WIC infants 4-5 months old, 284 non-breastfed WIC infants 6-12 months old, 285 non-breastfeeding postpartum adolescent and adult women, 49n, 288 pregnant or lactating adolescent and adult women, 49n, 287 WIC children 2-4 years old, 49n, 286 WIC children 12-24 months old, 49n, 285 of selected micronutrients and electrolytes, 54n, 274–283 breast-fed and non-breastfed WIC infants 6-11 months old, 94, 276 non-breastfed WIC infants 0-3 months old, 274 non-breastfed WIC infants 4-5 months old, 275 non-breastfeeding postpartum adolescent and adult women, 49n, 282–283 pregnant or lactating adolescent and adult women, 49n, 280–281 WIC children 1-2 years old, 49n, 277 WIC children 2-4 years old, 49n, 278–279 V Variety and choice for WIC participants changed from previous food packages, 117–120 fruits and vegetables, 117–119 milk products, 119–120 providing more, 117–120 Variety in the food supply increased, 29–30 increasing, 29–30 Vegetables. See Fruits and vegetables Vendors concerns about current food packages from, 164 consideration of administrative impacts on, 43–44 impact of changes in the WIC food packages on, 384 Vitamins DRIs used for assessing intakes of, 364–366 vitamin A, 12, 23, 31, 34, 47, 56, 102 estimates of upper levels, 58–59 vitamin C, 23, 31, 34, 47, 102 vitamin D, 12, 30, 119–120 and bone health, health risks from, 62 special recommendation for supplementation from the FNS, 171 supplementing, 16, 114n vitamin E, 47, 56–57, 60, 272 estimates of requirements, 58 vitamin K, supplementing, 114n Vouchers or other food instruments, workable procedures for, 172–173 W Washington, DC, Public Forum, 384–385 Water-soluble vitamins nutrient analysis of current and revised food packages using NDS-R, 230–231 nutrient analysis of current and revised food packages using USDA Nutrient Database for Standard Reference (SR-17), 240–241 White women, non-Hispanic, 32 WHO. See World Health Organization Whole-grain products in the breads and cereals, including only, 13–14 candidates for addition to the packages, 83 in Food Package IV for children, 11 including more, changed from previous food packages, 106 WIC. See Process used for revising the WIC food packages; Special Supplemental Nutrition Program for Women, Infants, and Children WIC agencies consideration of administrative impacts on, 44–45 impact of changes in the WIC food packages on, 383–384

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WIC Food Packages: Time for a Change WIC children 1-2 years old nutrients of concern with regard to inadequate intake by, 252–253 usual intake distributions of selected macronutrients (cholesterol and fiber), 49n, 285 usual intake distributions of selected micronutrients and electrolytes, 49n, 277 1-4 years old analysis sample, 271 priority nutrients for, 60 2-4 years old usual intake distributions of selected macronutrients (cholesterol and fiber), 49n, 286 usual intake distributions of selected micronutrients and electrolytes, 49n, 278–279 2-5 years old, nutrients of concern with regard to inadequate intake by, 252–253 WIC food instruments definitions of, 100 representations of, 266, 358–359 The WIC food packages, 23, 26–27 for children, 97–98 overview of the current food package for children, 97–98 revised food package for children, 98 revised WIC food packages, maximum monthly allowances for children and women, 90–92 current, maximum monthly allowances, 24–25 food priorities for, 46–73 for infants, 92–95 overview of current food packages for infants, 92–93 revised food packages for infants, 93–95 revised WIC food packages, maximum monthly allowances for infants, 88–89 nutrient priorities for, 46–60, 72–73 reasons to consider changes in, 27–36 for women, 95–97 overview of current food packages for women, 95 revised food packages for women, 96–97 revised WIC food packages, maximum monthly allowances for children and women, 90–92 WIC infants under 1 year old, non-breastfed, priority nutrients for, 59 WIC local agencies, concerns about current food packages from, 164 WIC Participant and Program Characteristics, 128, 132n, 137n, 350n, 354n The WIC population ethnic composition of, marked demographic changes in, 29 by participant category, marked demographic changes in, 28 The WIC Program marked changes in the annual number of participants, 27 staff and venders, addressing concerns of, 13–14 WIC state agencies, concerns about current food packages from, 164 Women in the childbearing years, food group priorities for, 65 comparison of estimated costs of current and revised food packages for, 130–131 estimated program costs for food per participant per month using current packages for, 132–133 using revised packages for, 136–137 revised Food Package III for, 99–100 revised food packages for, 96–97 WIC food packages for, 95–97 feeding method assumptions for, 316 women’s food packages, considering public comments about, 80 Workable procedures, 16, 172–174 fresh produce, 173–174 recommendations for, 16, 172–174 vouchers or other food instruments, 172–173 World Health Organization (WHO), 161n

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WIC Food Packages: Time for a Change Y Younger than 2 years old and low-income children, 68–71 dietary guidance for infants and children under the age of two years, 69–70 summary for infants and children younger than 2 years old, 71 Z Zinc, 12, 47–48, 56, 60, 115, 362n estimates of upper levels, 58–59 health risks from in breast-fed infants 6 through 12 months, 62

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