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Review of WIC Food Packages: Improving Balance and Choice: Final Report (2017)

Chapter: Appendix I: Complementary Feeding: Summary of Information Reviewed

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Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
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Appendix I

Complementary Feeding: Summary of Information Reviewed

To evaluate complementary feeding of infants in this report, the committee relied on food intake data from three large contemporary datasets: (1) Infant Feeding Practices Study II (IFPS II) (Grummer-Strawn et al., 2008), (2) 2008 Feeding Infants and Toddlers Study (FITS 2008) (Deming et al., 2014), and (3) National Health and Nutrition Examination Survey (NHANES) (Grimes et al., 2015). The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study, (WIC ITFPS II) is currently under way, but only limited results were available in time for this report. A summary of the study designs is presented in Table I-1 and key results are outlined in Tables I-2 and I-3.

Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

TABLE I-1 Study Designs and Characteristics of Selected Reports, IFPS II, FITS 2008, and NHANES 2005–2012

IFPS IIa FITS 2008b NHANES, 2005–2012c
Design Longitudinal data collected from the last trimester of pregnancy through infant’s first year of lifed Cross-sectional evaluation of dietary intake of U.S. children, 0–4 years Cross-sectional
Data Collection Dates May 2005–June 2007; 6-year follow-up in 2012d June 2008–January 2009 2005–2012
Recruitment Pregnant women who were part of a nationally distributed consumer opinion panel Sample frame came from the New Parent Database and the Consumer Database and the Consumer Database from the Experian, Inc. Complex, multistage, probability sampling
Eligibility Women at least 18 years of age Delivered a singleton infant who was at least 35 weeks gestation and weighed at least 5 pounds at birth Both mother and child were free from conditions that could affect feeding Household had child 0–47 months Non-institutionalized U.S. population
Sample Size 4,902 qualified in prenatal period 3,033 qualified in neonatal period 1,807 remained by end of study 3,273 infants and children 2,857 children enrollede 2,791 completed the first 24-hour dietary recall 2,740 had reliable dietary recall data 765 infants, 0–5.9 months 854 infants, 6–11.9 months 1,121 toddlers, 12–23.9 months
WIC Participants in Sample 1,112 (36.7%) of enrolled households (mother and/or infant) participated in WIC in the neonatal period 912 (30.1%) of 794 WIC infants and children
117 infants, 0–5.9 months
84 infants, 6–8.9 months
76 infants 9–11.9 months
238 toddlers,
Not identified in this analysis
Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
IFPS IIa FITS 2008b NHANES, 2005–2012c
enrolled households (mother and/or infants) participated in WIC any time from month 1 to 12 12–23.9 months
279 preschoolers,
24–47.9 months
Data Collection Mail-based survey Sent monthly approximately 2–7 months postpartum, then approximately every 7 weeks thereafter through 12 months postpartum Phone-based Face-to-face interview
Dietary Assessmentf Food frequency table of liquids and solids the infant consumed in previous 7 days Quantities consumed not captured 24-hour recall and brief questionnaire
Second 24-hour recall performed in a subsample, 7–10 days after first (n = 701)h
Descriptive findings of unadjusted prevalence are presented for WIC vs. non-WIC participants; analyses used sample weights and groups were compared using t-testsg
24-hour proxy-recalli Evaluated contributions of foods to energy and nutrient intake

NOTES: FITS = 2008 Feeding Infants and Toddlers Study; IFPS II = Infant Feeding Practices Study II; NHANES = National Health and Nutrition Examination Survey.

a Overall study design, Fein et al., 2008; CDC, 2014.

b Overall study design, Briefel et al., 2010.

c Grimes et al., 2015.

d A year 6 follow-up study of children initially assessed in the IFPS II has been conducted, evaluating links between early feeding practices and various health outcomes (Fein et al., 2014).

e Number represents sample included in the analysis, not entire NHANES sample.

f Information about dietary supplement use was collected in each of the overall study designs, but the three reports on food group intakes did not evaluate supplement use.

g Report-specific analysis, Deming et al., 2014.

h Two days of dietary intake per sampled child was used to calculate usual nutrient intake distributions, Briefel et al., 2010.

i While two 24-hour recalls are part of the NHANES procedures, Grimes et al. (2015) only evaluated intake reported on the first day of recall.

SOURCES: CDC, 2014; Fein et al., 2008, 2014; Grimes et al., 2015.

Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

TABLE I-2 Complementary Food Intake of Infants, Ages 0 to 2 Years, from IFPS II and FITS II

Food Group IFPS IIa FITS 2008b
Age in Months Percent Consuming in the Previous Week Age in Months Percent Consuming on a Given Day
WIC Non-WIC
Fruit (excluding juice) 3 2.8 0–5.9 8.6c 6.4c
6 71.3 6–11.9 69.1 75.6
9 97.0 12–23.9 62.3 83.6d
12 98.4
100% Juice 3 5.0 0–5.9 8.2c 3.8c
6 33.4 6–11.9 46.1 28.3e
9 62.8 12–23.9 61.9 52.4
12 76.9
Vegetables, total 3 1.4 0–5.9 11.2c 8.4
6 73.1 6–11.9 57.7 75.6e
9 97.2 12–23.9 73.5 69.5
12 98.7
Grains and grain products, total 3 18.3 0–5.9 26.7 22.7
6 86.1 6–11.9 91.5c 90.3
9 96.3 12–23.9 99.5c 98.4c
12 97.0
Infant cereal 3 18.2 0–5.9 26.7 21.9
6 83.7 6–11.9 61.8 66.9
9 83.4 12–23.9 6.9c 11.4
12 46.6
Meats and meat substitutesf 3 0.7 0–5.9 2.8c 0.0c
6 22.0 6–11.9 64.1 53.6
9 78.4 12–23.9 93.9c 94.1
12 96.6
Cow’s milk, total 3 0.3 0–5.9 0.0 0.0
6 1.2 6–11.9 13.3 9.4
9 5 3 12–23 9 86 5 81 0
12 . 81.2 . . .
Cow’s milk, whole NR 6–11.9 10.0c 7.8
12–23.9 59.2 64.2
Cow’s milk, reduced- or low-fat NR 6–11.9 2.7c 1.1c
12–23.9 31.8 19.7e
Cow’s milk, nonfat NR 6–11.9 0.5 0.1c
12–23.9 1.0c 1.0
Sweetened beverages 3 1.1 0–5.9 0.0c 0.3c
6 3.1 6–11.9 12.3c 4.5c
9 6.2 12–23.9 39.6 22.0
12 14.6
Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
Food Group IFPS IIa FITS 2008b
Age in Months Percent Consuming in the Previous Week Age in Months Percent Consuming on a Given Day
WIC Non-WIC
Desserts and candy 3 0.2 0–5.9 1.7c 1.1c
6 1.5 6–11.9 22.7 24.8
9 12.3 12–23.9 63.6 55.5
12 52.2

NOTES: NR = not reported.

a Grummer-Strawn et al., 2008.

b Deming et al., 2014 (data reprinted with permission).

c Point estimate imprecise due to small sample size and it being an uncommon or very common response.

d Significantly different from WIC group at 0.01 level by t-test.

e Significantly different from WIC group at 0.05 level by t-test.

f FITS 2008 classified this category as “Meat and other protein sources” and included cheese and yogurt in this category while IFPS II has a separate “Other Dairy” category.

SOURCES: Grummer-Strawn et al., 2008; Deming et al., 2014.

Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

TABLE I-3 Percent of Daily Energy Intake of Complementary Food Groups by Infants Ages 6 to 23.9 Months, NHANES 2005–2012a

Food Group Percent of Daily Energy Intake
6–11.9 months 12–23.9 months
Fruit (excluding juice) 2.3 4.8
100% Juice 1.5 5.9
Vegetables NAb 3.2c
Grains and grain products
Mixed dishes—grain-based 2.3 5.5
Bread, rolls, tortillas 1.1 3.8
Crackers NA 2.4
Ready-to-eat cereal NA 2.3
Quick breads and bread products NA 1.6
Cooked cereals NA 1.4
Meats and meat substitutes
Poultry NA 3.6
Cured meats and poultry NA 2.5
Eggs NA 2.2
Mixed dishes—meat, poultry, seafood NA 2.0
Plant-based protein foods NA 1.6
Dairy
Cow’s milk, all fat levels 3.1 22.4
Cheese NA 2.6
Yogurt NA 1.7
Flavored milk NA 1.3
Desserts, sweetened beverages, and savory snacks
Sweet bakery products 1.8 4.6
Sweetened beverages NA 3.1
Savory snacks NA 2.4
Candy NA 1.3
Other desserts NA 1.2

NOTES: NA = data not available.

a Intake of human milk and infant formulas not represented in this table.

b All NA notations indicate that data were not presented in Grimes et al. (2015), as intake contributed to less than 1 percent of total energy intake.

c Sum of “White Potatoes” group and “Vegetables, excluding potatoes” group.

SOURCE: Grimes et al., 2015.

Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

REFERENCES

Briefel, R. R., L. M. Kalb, E. Condon, D. M. Deming, N. A. Clusen, M. K. Fox, L. Harnack, E. Gemmill, M. Stevens, and K. C. Reidy. 2010. The Feeding Infants and Toddlers Study 2008: Study design and methods. Journal of the American Dietetic Association 110(12 Suppl):S16–S26.

CDC (Centers for Disease Control and Prevention). 2014. Infant Feeding Practices Study II and its year six follow-up, chapter 2: Neonatal survey. http://www.cdc.gov/ifps/pdfs/data/ifps2_tables_ch2.pdf (accessed December 20, 2016).

Deming, D. M., R. R. Briefel, and K. C. Reidy. 2014. Infant feeding practices and food consumption patterns of children participating in WIC. Journal of Nutrition Education and Behavior 46(3 Suppl):S29–S37.

Fein, S. B., J. Labiner-Wolfe, K. R. Shealy, R. Li, J. Chen, and L. M. Grummer-Strawn. 2008. Infant Feeding Practices Study II: Study methods. Pediatrics 122(Suppl 2):S28–S35.

Fein, S. B., R. Li, J. Chen, K. S. Scanlon, and L. M. Grummer-Strawn. 2014. Methods for the year 6 follow-up study of children in the Infant Feeding Practices Study II. Pediatrics 134(Suppl 1):S4–S12.

Grimes, C. A., E. A. Szymlek-Gay, K. J. Campbell, and T. A. Nicklas. 2015. Food sources of total energy and nutrients among U.S. infants and toddlers: National Health and Nutrition Examination Survey 2005–2012. Nutrients 7(8):6797–6836.

Grummer-Strawn, L. M., K. S. Scanlon, and S. B. Fein. 2008. Infant feeding and feeding transitions during the first year of life. Pediatrics 122(Suppl 2):S36–S42.

Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×

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Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
Page 553
Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
Page 554
Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
Page 555
Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
Page 556
Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
Page 557
Suggested Citation:"Appendix I: Complementary Feeding: Summary of Information Reviewed." National Academies of Sciences, Engineering, and Medicine. 2017. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington, DC: The National Academies Press. doi: 10.17226/23655.
×
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The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and post-partum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population.

To assure the continued success of the WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) reevaluate the program's food packages every 10 years. In 2014, the USDA asked the Institute of Medicine to undertake this reevaluation to ensure continued alignment with the goals of the Dietary Guidelines for Americans. In this third report, the committee provides its final analyses, recommendations, and the supporting rationale.

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