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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
younger than 1 year old
changes in potential intakes paralleling changes in nutrients provided in the packages, 150
nutrient intake profiles for, 298–299
Formula feeding, 69
consistency of the revised food packages for infants and children under 2 years old with established dietary recommendations, 158–159
in Food Package II, 7
Fortification of food, 177
Four Food Groups, 34
Fragile Families and Child Well-Being Study, 109, 174
Fresh produce
an option for children and women, 104
workable procedures for, 173–174
Freshness of fruits and vegetables, ensuring, 13, 30
Fruits and vegetables, 12, 14.
See also Processed fruit and vegetable option
amounts provided by current and revised food packages compared with amounts suggested for caloric level, 156–157
candidates for addition to the packages, 82
comparison of food items used in nutrient analyses from two databases, 246–249
definitions of food instruments, 100
effects on program staff and vendors of adding, 105–106
in Food Package IV for children, 9
including in the WIC food packages, 101–106
changed from previous food packages, 101–106
price data on, 127
promoting the consumption of whole, 13
proposed specifications for, 121
providing more flexibility for WIC state agencies and more variety and choice for WIC participants, 117–119
rationale for adding, 100–103
specific recommendations, 103–105
specifications for foods in the revised food packages, 218–219
FSRG. See Food Surveys Research Group
Fully breast-fed infants, 209
6-12 months old, nutrients and ingredients to limit in the diet of, 260
Fully breastfeeding women
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
Fully formula-fed infants, 208–210
0-4 months old, nutrients of concern with regard to excessive intake by, 256–257
4-6 months old, nutrients of concern with regard to excessive intake by, 256–257
6-12 months old
nutrients and ingredients to limit in the diet of, 260
nutrients of concern with regard to excessive intake by, 256–257
amounts of infant formula provided to, 113–114
Food Package I for, 6
G
GAO. See U.S. General Accounting Office (now U.S. Government Accountability Office)
Grains. See also Whole-grain products
amounts provided by current and revised food packages compared with amounts suggested for caloric level, 156–157
comparison of food items used in nutrient analyses from two databases, 248–249
proposed specifications for, 122–123
specifications for foods in the revised food packages, 222–223
Gray, George M., 375–376
Groceries, price data on, 127–128
H
Handling food in the home, and nutrition education, 176
Harrison, Gail G., 376
Hazard identification, 293
Health risks of the WIC-eligible population, changes in, 31–33
Healthier eating patterns
developing, 70
studies on changes to promote, 169–171
Healthy People 2010, 38, 61, 68, 79, 108
HHS Blueprint for Action on Breastfeeding, 108
High-quality protein, 23
I
Impacts of changes in the WIC food packages
on vendors, 384
on WIC agencies, 383–384
Implementation. See also Studies related to implementation and its effects
and its effects, studies on, 167–171
Improved nutrient intakes, supporting, 11–12
Inadequate usual intake
nutrients of concern with regard to, 304–307
proportion of subgroup with, 268–269
providing greater amounts of nutrients with, 146–148
Incentive value, 43
Incentivizing breastfeeding, possibilities for, 383
Income eligibility, required for the WIC program, 22
Infant Feeding Practices Study, 109
Infant foods
comparison of food items used in nutrient analyses from two databases, 246–247
proposed specifications for, 121
specifications for foods in the revised food packages, 218–219
Infant formula
amounts provided, 113–114
price data on, 127
rebate assumption, 128
Infants and children younger than 2 years old
dietary guidance for, 69–70
summary for, 71
Infants in the WIC program
0-3 months old, 315
1-3 months old, revised Food Package I for, 93–94
4-5 months old, 315
4 months old, revised Food Package I at, 94
6-12 months old, 315
6 months old, Food Package II at, 94
bases of assumptions used in nutrient and cost analyses of food packages for, 138n, 315n, 318–323
calculated costs of representative amounts of foods in revised packages for, 342–343
comparison of estimated costs of current and revised food packages for, 130–131
considering public comments about food packages, 80
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
feeding method assumptions for, 315–316
revised Food Package III for, 99
revised food packages for, 93–95
WIC food packages for, 92–95
Information Resources, Inc. (IRI), 127
Institute of Medicine, The National Academies (IOM), 2, 15, 21, 23, 82, 97n, 102, 107, 118, 120, 363n, 370n
Committee to Review the WIC Food Packages, 2, 11–14
Intakes of WIC-eligible subgroups
DRIs used for assessing, 360–374
elements, 360–363
selected fats, 372–374
selected macronutrients, 368–370
vitamins, 364–366
International Zinc Nutrition Consultative Group (IZiNCG), 149n
IOM. See Institute of Medicine
Iowa State University (ISU) method, 268
IRI. See Information Resources, Inc.
Iron-deficiency anemia, 61
ISU. See Iowa State University
IZiNCG. See International Zinc Nutrition Consultative Group
J
Jensen, Helen H., 376–377
Juice
in Food Package IV for children, 8
K
Kaiser, Lucia L., 377
Kinsey, Jean D., 377–378
Korean Americans, 42
L
Lactating women 14-44 years old
nutrients and ingredients to limit in the diet of, 260
nutrients of concern with regard to excessive intake by, 258–259
nutrients of concern with regard to inadequate intake by, 254–255
Lactation, defined, 97
Listerosis, 39
Local WIC State Agency, 383
Low-fat, defined, 107n
Low-income children
2-4 years old, and women, 64
younger than 2 years old, 68–71
M
Macronutrients
and added sugars, reported usual intakes outside dietary guidance, 53
DRIs used for assessing intakes of selected, 368–370
nutrient analysis of current and revised food packages
using SR-17, 242–243
requirements for adults, 58
March of Dimes Birth Defects Foundation, 61
Market baskets of food, 23
Market value of the packages for the mother/infant pair, in promoting and supporting breastfeeding, 109–110
Maximum monthly allowances
for children and women in the revised WIC food packages, 90–92
for infants in the revised WIC food packages, 88–89
for proposed Food Package II for infants ages 6 months to 1 year, 7
food groups, 7
specialty foods, 7
in revised WIC food packages for children and women, 90–92
Mean numbers of servings from five basic food groups consumed by selected age groups, 66–67
Meat and alternatives
amounts provided by current and revised food packages compared with amounts suggested for caloric level, 156–157
comparison of food items used in nutrient analyses from two databases, 248–251
proposed specifications for, 123
specifications for foods in the revised food packages, 223–224
Methodological approaches, 383
Local WIC State Agency, 383
National WIC Association, 383
USDA, 383
Methods of cost evaluation, 126–131
data, 126–128
estimating food package costs, 129
estimating program costs for food, 129–131
Methylmercury, health risks from, 63
Mexican American women, 32
Micronutrients and protein, estimated prevalence of inadequacy of
using usual intakes for children and women, 49
using usual intakes for infants, 48
Milk and milk alternatives
amounts provided by current and revised food packages compared with amounts suggested for caloric level, 156–157
candidates for addition to the packages, 83
comparison of food items used in nutrient analyses from two databases, 248–249
fat content of, 96
fat-reduced, 107
in Food Package IV for children, 9
proposed specifications for, 122
providing more flexibility for WIC state agencies and more variety and choice for WIC participants, 119–120
specifications for foods in the revised food packages, 220–222
Mineral absorption, increases in dietary fiber interfering with, 302
Minimizing early supplementation, 111–112
basis for policy change, 111–112
in promoting and supporting breastfeeding, 111–112
proposed policy change related to initial
food package options for mother/infant pairs after delivery, 111
Multiplier effects, changes in food packages possibly having, 302
Murphy, Suzanne P., 378
N
National Advisory Council on Maternal, Infant, and Fetal Nutrition (NACMIFN), 23
National Association of WIC Directors (NAWD). See National WIC Association
National Health and Nutrition Examination Survey (NHANES), 32–33, 60–61
National Immunization Survey, 351n, 354n
National Maternal and Infant Health Survey, 174
National Research Council (NRC), 268–269
National WIC Association (formerly National Association of WIC Directors) (NWA), 35, 41, 80, 383
NAWD. See National Association of WIC Directors
NCC. See Nutrition Coordinating Center, University of Minnesota
NDL. See Nutrient Data Laboratory, U.S. Department of Agriculture
NDS-R. See Nutrient Data System for Research
nutrient analysis of current and revised food packages using, 226–235
NEs. See Niacin Equivalents
New dietary guidance, 34–35
New nutrient recommendations, 33–34
NHANES. See National Health and Nutrition Examination Survey
Niacin equivalents (NEs), 365n
NOAELs (No Observed Adverse Effect Levels), 149n
Non-breastfed infants younger than 1 year old
direction of changes in the level of priority nutrients in the revised food packages for, 147
non-breastfed WIC infants 0-3 months old
usual intake distributions of selected macronutrients (cholesterol and fiber), 284
usual intake distributions of selected micronutrients and electrolytes, 274
non-breastfed WIC infants 4-5 months old
usual intake distributions of selected macronutrients (cholesterol and fiber), 284
usual intake distributions of selected micronutrients and electrolytes, 275
non-breastfed WIC infants 6-12 months old
usual intake distributions of selected macronutrients (cholesterol and fiber), 285
usual intake distributions of selected micronutrients and electrolytes, 94, 276
Non-breastfeeding postpartum women
14-44 years old
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, 252–255
adolescent and adult
usual intake distributions of selected macronutrients (cholesterol and fiber), 49n, 288
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
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
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
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
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
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
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
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
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
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
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
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
Standards of Identity, 225n
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
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
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
and bone health, health risks from, 62
special recommendation for supplementation from the FNS, 171
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
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
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
