nutrition risk criteria used by the WIC program. These concepts, in conjunction with the concepts of indicators of risk and indicators of benefit, have implications that underlie both the assessments of the nutrition risk criteria used by the WIC program and the development of the report's conclusions and recommendations. In particular, risk indicators and cutoff points should be chosen such that the highest proportion of those who are truly at risk can be identified and the highest proportion of those identified can benefit from WIC program participation. With limited program resources, cutoff points should be set with less than perfect sensitivity to increase yield, recognizing that as cutoff points become more restrictive, some individuals who could benefit from WIC services will not be served. The decision process presented in Chapter 3 can be used to review other risk criteria that the WIC program may be asked to approve in the future.
The committee reached seven general conclusions about the WIC nutrition risk criteria and priority system:
- A body of scientific evidence supports a majority of the nutrition risk criteria used by the WIC program. For some of the risk criteria, however, there are serious gaps in the evidence.
- Nutrition risk criteria used by many states have a high sensitivity and low yield of benefit. This is because the prevalence of many of the risk conditions is low and the cutoffs used are generous, resulting in both the selection of many of those who have the risk condition (high sensitivity) and the selection of many individuals who do not have the risk condition (low yield of risk, which results in low yield of benefit).
- Use of generous cutoff points or loosely defined conditions in categories designated by federal regulation to receive high priority for eligibility may result in denial of services to individuals who are actually at higher nutrition risk. When resources are limited, individuals in lower priority categories may not be served even if their true risk is very high, while those in high priority categories must be served. Very generous cutoff points produce a low yield of benefit without any increase in sensitivity (serving more of those truly at risk). Loosely defined risk conditions are those that encompass a broad range of medical problems with varying degrees of nutrition risk or potential to benefit from WIC participation. Such loosely defined nutrition risk criteria include endocrine disorders, renal disease, chronic and recurrent infections, food allergies, and genetic and congenital disorders.
- There is some inconsistency between the WIC program's goals, design, and implementation. The goal of the WIC program is one of primary prevention—to prevent the occurrence of health problems. Through the use of nutrition