Framework for Dietary Risk Assessment in the WIC Program: InterimReport

Committee on Dietary Risk Assessment in the WIC Program

Food and Nutrition Board

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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Framework for Dietary Risk Assessment in the WIC Program: InterimReport Framework for Dietary Risk Assessment in the WIC Program: InterimReport Committee on Dietary Risk Assessment in the WIC Program Food and Nutrition Board INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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Framework for Dietary Risk Assessment in the WIC Program: InterimReport NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approvedby the Governing Board of the National Research Council, whose membersare drawn from the councils of the National Academy of Sciences,the National Academy of Engineering, and the Institute of Medicine.The members of the committee responsible for the report were chosenfor their special competences and with regard for appropriate balance. Support for this project was provided by the Food and Nutrition Service,U.S. Department of Agriculture under contract number 59-3198-9-027.The opinions or conclusions expressed herein are those of the committeeand do not necessarily reflect those of the funders. International Standard Book Number 0-309-07263-8 This report is available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055; call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's on-line bookstore at www.nap.edu. For more information about the Institute of Medicine or the Foodand Nutrition Board, visit the IOM home page at www.iom.edu. Copyright 2000 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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Framework for Dietary Risk Assessment in the WIC Program: InterimReport “Knowing is not enough; we must apply. Willing is not enough; we must do. —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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Framework for Dietary Risk Assessment in the WIC Program: InterimReport THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguishedscholars engaged in scientific and engineering research, dedicatedto the furtherance of science and technology and to their use forthe general welfare. Upon the authority of the charter granted toit by the Congress in 1863, the Academy has a mandate that requiresit to advise the federal government on scientific and technical matters.Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academyof Sciences, as a parallel organization of outstanding engineers.It is autonomous in its administration and in the selection of itsmembers, sharing with the National Academy of Sciences the responsibilityfor advising the federal government. The National Academy of Engineeringalso sponsors engineering programs aimed at meeting national needs,encourages education and research, and recognizes the superior achievementsof engineers. Dr. William A. Wulf is president of the National Academyof Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to securethe services of eminent members of appropriate professions in theexamination of policy matters pertaining to the health of the public.The Institute acts under the responsibility given to the NationalAcademy of Sciences by its congressional charter to be an adviserto the federal government and, upon its own initiative, to identifyissues of medical care, research, and education. Dr. Kenneth I. Shineis president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associatethe broad community of science and technology with the Academy'spurposes of furthering knowledge and advising the federal government.Functioning in accordance with general policies determined by theAcademy, the Council has become the principal operating agency ofboth the National Academy of Sciences and the National Academy ofEngineering in providing services to the government, the public,and the scientific and engineering communities. The Council is administeredjointly by both Academies and the Institute of Medicine. Dr. BruceM. Alberts and Dr. William A. Wulf are chairman and vice chairman,respectively, of the National Research Council.

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Framework for Dietary Risk Assessment in the WIC Program: InterimReport COMMITTEE ON DIETARY RISK ASSESSMENT IN THE WIC PROGRAM VIRGINIA A. STALLINGS (Chair), Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania TOM BARANOWSKI, Department of Pediatrics, Baylor College of Medicine, Houston, Texas YVONNE BRONNER, Masters of Public Health and Doctor of Public Health Program, Morgan State University, Baltimore, Maryland LAURA E. CAULFIELD, Division of Human Nutrition, Johns Hopkins University, Baltimore,Maryland EZRA C. DAVIDSON, JR., Primary Care, Charles R. Drew University of Medicine and Science,Los Angeles, California THERESA O. SCHOLL, Department of Obstetrics and Gynecology, University of Medicine andDentistry of New Jersey, Stratford CAROL W. SUITOR, Nutrition Consultant, Northfield, Vermont ROBERT C. WHITAKER, Division of General and Community Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio Staff Romy Gunter-Nathan, Study Director Kimberly Freitag, Research Assistant Shelley Goldberg, Senior Project Assistant Geraldine Kennedo, Project Assistant

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Framework for Dietary Risk Assessment in the WIC Program: InterimReport FOOD AND NUTRITION BOARD CUTBERTO GARZA (Chair), Division of Nutritional Science, Cornell University, Ithaca, NewYork ALFRED H. MERRILL, JR. (Vice Chair), Center for Nutrition and Health Sciences, Emory University, Atlanta,Georgia ROBERT M. RUSSELL (Vice Chair), Jean Mayer U.S. Department of Agriculture Human Nutrition ResearchCenter on Aging, Tufts University, Boston, Massachusetts VIRGINIA A. STALLINGS (Vice Chair), Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Pennsylvania LARRY R. BEUCHAT, Center for Food Safety and Quality Enhancement, University of Georgia,Griffin BENJAMIN CABALLERO, Center for Human Nutrition, Johns Hopkins School of Hygiene and PublicHealth, Baltimore, Maryland FERGUS M. CLYDESDALE, Department of Food Science, University of Massachusetts at Amherst ROBERT J. COUSINS, Center for Nutritional Sciences, University of Florida, Gainesville SCOTT M. GRUNDY, Center for Human Nutrition, University of Texas Southwestern MedicalCenter at Dallas SHIRIKI KUMANYIKA, Center for Clinical Epidemiology and Biostatistics, University ofPennsylvania, Philadelphia LYNN PARKER, Child Nutrition Programs and Nutrition Policy, Food Research andAction Center, Washington, D.C. ROSS L. PRENTICE, Division of Public Health Sciences, Fred Hutchinson Cancer ResearchCenter, Seattle, Washington A. CATHARINE ROSS, Department of Nutrition, The Pennsylvania State University, UniversityPark ROBERT E. SMITH, R.E. Smith Consulting, Inc., Newport, Vermont STEVE L. TAYLOR, Food Processing Center, University of Nebraska-Lincoln Staff Allison A. Yates, Director Gail E. Spears, Administrative Assistant Gary Walker, Financial Associate

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Framework for Dietary Risk Assessment in the WIC Program: InterimReport Acknowledgments Many individuals volunteered significant time and effort to addressand educate the committee at its workshop and public meeting. Workshopspeakers included Jean Anliker, Ph.D., R.D. of the University ofMaryland; Valerie Tarasuk, Ph.D. of the University of Toronto; CutbertoGarza, M.D., Ph.D. of Cornell University; Kristin Marcoe, M.B.A.,R.D. of the United States Department of Agriculture; Amy Subar, Ph.D.,M.P.H., R.D. of the National Cancer Institute; Gladys Block, Ph.D.of the University of California, Berkeley; Graham Colditz, M.D.,Dr.P.H. of Harvard University; Anna Maria Siega-Riz, Ph.D. of theUniversity of North Carolina; Jill Leppert of the North Dakota StateDepartment of Health; Amanda Watkins, M.S., R.D. of the Arizona Departmentof Health Services; Ann Barone of the Rhode Island Department ofHealth; Carol Rankin, M.S., R.D., L.D. of the Mississippi Departmentof Health; Bob Greenstein of the Center on Budget and Policy Priorities,Washington, D.C.; and Lynn Parker of the Food Research and ActionCenter, Washington, D.C. In addition, the following organizations provided oral testimonyto the committee during its public meeting: National Associationof WIC Directors and the Food and Nutrition Service, United StatesDepartment of Agriculture. The report was also reviewed in draft form by individuals chosenfor their diverse perspectives and technical expertise, in accordancewith procedures approved by the NRC's Report Review Committee. Thepurpose of this independent review is to provide candid and criticalcomments that will assist the institution in making its publishedreport as sound as possible and to ensure that the report meets institutionalstandards for objectivity, evidence, and responsiveness to the studycharge. The review comments and draft manuscript remain confidentialto protect the integrity of the deliberative process. We wish tothank the following individuals for their review of this report:Janet Allen, M.A., R.D., North Central Florida Maternal & InfantCare Project, WIC; Barbara A. Dennison, M.D., Associate Professorof Clinical Pediatrics, Columbia University and Attending Pediatricianand Research Scientist, Research Institute, Bassett Healthcare; Dr.Bernard Dreyer, Associate Chair of Pediatrics, Department of Pediatrics,New York University and Bellevue Hospital Center; Gail G. Harrison,Ph.D., Professor and Chair, Department of Public Health and CommunityHealth Science, UCLA Center for Human Nutrition; Maxine Hayes, M.D.,M.P.H., Assistant Secretary of Community & Family Health, WashingtonState Department of Health and University of Washington School ofMedicine; and Michele Lawler, Public Health Analyst, Department ofHealth and Human Services, Health Resources and Services Administration,Maternal and Child Health Bureau. Although the reviewers listed above provided many constructive commentsand suggestions, they were not asked to endorse the conclusions orrecommendations nor did they see the final draft of the report beforeits release. The review of this report was overseen by Richard E.Behrman, M.D., J.D., Vice President for Medical Affairs, Lucile PackardFoundation for Children's Health, appointed by the Institute of Medicine,who was responsible for making certain that an independent examinationof this report was carried out in accordance with institutional proceduresand that all review comments were carefully considered. Responsibilityfor the final content of this report rests entirely with the authoringcommittee and the institution.

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Framework for Dietary Risk Assessment in the WIC Program: InterimReport Contents     SUMMARY   1     ASSESSING DIETARY RISK AMONG WIC PROGRAM APPLICANTS   3     APPENDIXES    A.   Workshop Agenda and Presentations   21  B.   Literature Search   67

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