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Suggested Citation:"Appendix L: Gap Analysis." 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 L

Gap Analysis

The committee conducted a gap analysis to determine the average intake of a nutrient that would be needed to ensure an acceptable level of inadequacy in a population (for this report, 5 percent of the population subgroup or less). For nutrients with an Estimated Averaged Requirement (EAR) and for which intake was inadequate, the gap is the difference between the EAR and the 5th percentile of intake; for nutrients with an Adequate Intake (AI) and for which intake was below the AI, the gap is the difference between the AI and the median intake; for sodium, for which there is excess intake, the gap is the difference between the Tolerable Upper Intake Level (UL) and the 95th percentile of intake. For added sugars and saturated fat, the gap is the difference between the upper limit (the value that is 10 percent of the associated kcal pattern) and the 95th percentile of intake. Two gaps were evaluated for nutrients with an EAR: the gap to shift the subgroup to 5 percent inadequacy or less and to 10 percent inadequacy or less.

Results of the gap analysis for nutrients that were categorized as higher, middle, or lower priority in Chapter 5, Tables 5-2 through 5-6 are presented below in Tables L-1 through L-6. Within each priority group, nutrients are ordered from the highest to lowest percent of inadequacy. Nutrients for which intakes exceeded a recommended upper limit (sodium, saturated fat, and added sugars) are presented last in the order. The gap was not evaluated for nutrients for which intakes exceeding the UL were not of concern, as described in Chapter 4. Meeting the gap identified for the nutrients that were evaluated did not result in any subgroups with nutrient intakes over the UL.

Suggested Citation:"Appendix L: Gap Analysis." 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 L-1 Gap Analysis Summary for Pregnant WIC-Participating Women

Nutrient EAR/AI* 5th Percentile 10th Percentile Median UL 95th Percentile
Intake Gap Intake Gap Intake Gap Intake Gap
Higher Priority
Iron (mg/d) 22 11.5 10.5 12.6 9.4 45 26.5
Choline (mg/d) 450* 348 102 3,500 469
Potassium (mg/d) 4,700* 2,952 1,748
Fiber (g/d) 28* 18 10
Sodium (mg/d) 1,500* 3,566 0 2,300 4,930 2,630
Saturated fat (g/d) 29 44 15
Added sugars (g/d) 65 212 147
Middle Priority
Folate (µg DFE/d) 520 412 108 454 66
Lower Priority
Magnesium (mg/d) 290 221 69 241 49
Vitamin A (µg RAE/d) 550 426 124 480 70
Zinc (mg/d) 9.5 7.7 1.8 8.5 1 40 17.2
Vitamin C (mg/d) 70 46 24 58 12 2,000 244
Vitamin B6 (mg/d) 1.6 1.4 0.2 1.6 0.1 100 3.3
Serum Vitamin D (nmol/L) 40 36 4 41 0
Calcium (mg/d) 800 773 27 871 0 2,500 1,791

NOTES: N = 165. — = not applicable; AI = Adequate Intake; DFE = dietary folate equivalents; EAR = Estimated Average Requirement; RAE = retinol activity equivalents; UL = Tolerable Upper Intake Level. For nutrients with an AI, the median and gap between the median and AI are indicated. For nutrients with an EAR, 5th and 10th percentile gaps are evaluated. Shaded nutrients are nutrients to limit; for these, the gaps to reduce the prevalence of excessive intake to 5 percent were evaluated. For sodium, this is the 95th percentile gap compared to the UL. For saturated fat and added sugar, the 95th percentile intakes are compared to the Dietary Guidelines for Americans upper limit of 10 percent of kcal.

* Values with an asterisk are AIs; otherwise, EARs are indicated in this column.

SOURCES: IOM, 1998, 2000, 2001, 2002/2005, 2005, 2011; USDA/ARS, 2005–2012; USDA/HHS, 2016.

Suggested Citation:"Appendix L: Gap Analysis." 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 L-2 Gap Analysis Summary for Breastfeeding WIC-Participating Women

Nutrient EAR/AI * 5th Percentile 10th Percentile Median UL 95th Percentile
Intake Gap Intake Gap Intake Gap Intake Gap
Higher Priority
Potassium (mg/d) 5,100* 2,846 2,254
Fiber (g/d) 29* 16 13
Sodium (mg/d) 1,500* 3,191 0 2,300 4,439 2,139
Saturated fat (g/d) 29 46 17
Added sugars (g/d) 65 194 129
Middle Priority
Folate (µg DFE/d) 450 323 127 360 90
Serum Vitamin D (nmol/L) 40 28 12 33 7
Calcium (mg/d) 800 664 136 738 62 2,500 1,689
Lower Priority
Vitamin A (µg RAE/d) 900 402 498 459 441
Magnesium (mg/d) 255 182 73 199 56
Zinc (mg/d) 10.4 7.1 3.3 8 2.4 40 15.4
Vitamin C (mg/d) 100 53 47 65 35 2,000 257
Vitamin B6 (mg/d) 1.7 1.2 0.5 1.3 0.4 100 3.5
Copper (mg/d) 1 0.8 0.2 0.9 0.1 10 1.7
Thiamin (mg/d) 1.2 1.1 0.1 1.2 0

NOTES: N = 27. — = not applicable; AI = Adequate Intake; DFE = dietary folate equivalents; EAR = Estimated Average Requirement; RAE = retinol activity equivalents; UL = Tolerable Upper Intake Level. For nutrients with an AI, the median and gap between the median and AI are indicated. For nutrients with an EAR, 5th and 10th percentile gaps are evaluated. Shaded nutrients are nutrients to limit; for these, the gaps to reduce the prevalence of excessive intake to 5 percent were evaluated. For sodium, this is the 95th percentile gap compared to the UL. For saturated fat and added sugar, the 95th percentile intakes are compared to the Dietary Guidelines for Americans upper limit of 10 percent of kcal.

* Values with an asterisk are AIs; otherwise, EARs are indicated in this column.

SOURCES: IOM, 1998, 2000, 2001, 2002/2005, 2005, 2011; USDA/ARS, 2005–2012; USDA/HHS, 2016.

Suggested Citation:"Appendix L: Gap Analysis." 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 L-3 Gap Analysis Summary for Postpartum WIC-Participating Women

Nutrient EAR/AI* 5th Percentile 10th Percentile Median UL 95th Percentile
Intake Gap Intake Gap Intake Gap Intake Gap
Higher Priority
Calcium (mg/d) 800 429 371 496 304 2,500 1,301
Potassium (mg/d) 4,700* 1,898 2,802
Fiber (g/d) 25* 12 13
Sodium (mg/d) 1,500* 2,793 0 2,300 4,071 1,771
Added sugars (g/d) 58 199 142
Middle Priority
Folate (µg DFE/d) 320 189 131 225 95
Serum Vitamin D (nmol/L) 40 30 10 37 3
Iron (mg/d) 8.1 6.5 1.6 7.6 0.5 45 23.5 21.5
Saturated fat (g/d) 26 34 8
Suggested Citation:"Appendix L: Gap Analysis." 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.
×
Lower Priority
Magnesium (mg/d) 265 121 144 139 126
Vitamin A (µg RAE/d) 500 145 355 184 316
Vitamin C (mg/d) 60 23 37 30 30 2,000 186
Copper (mg/d) 0.7 0.5 0.3 0.5 0.2 10 1.3
Zinc (mg/d) 6.8 4.3 2.5 5.1 1.7 40 13.9
Thiamin (mg/d) 0.9 0.7 0.2 0.8 0.1
Vitamin B6 (mg/d) 1.1 0.8 0.3 0.9 0.2 100 2.3
Vitamin B12 (mg/d) 2.0 1.4 0.6 1.7 0.3
Riboflavin (mg/g) 0.9 0.8 0.2 0.9 0
Niacin (mg/d) 11 10.6 0.4 12.0 0

NOTES: N = 62. — = not applicable; AI = Adequate Intake; DFE = dietary folate equivalents; EAR = Estimated Average Requirement; RAE = retinol activity equivalents; UL = Tolerable Upper Intake Level. For nutrients with an AI, the median and gap between the median and AI are indicated. For nutrients with an EAR, 5th and 10th percentile gaps are evaluated. Shaded nutrients are nutrients to limit; for these, the gaps to reduce the prevalence of excessive intake to 5 percent were evaluated. For sodium, this is the 95th percentile gap compared to the UL. For saturated fat and added sugar, the 95th percentile intakes are compared to the Dietary Guidelines for Americans upper limit of 10 percent of kcal.

* Values with an asterisk are AIs; otherwise, EARs are indicated in this column.

SOURCES: IOM, 1997, 1998, 2000, 2001, 2002/2005, 2005, 2011; USDA/ARS, 2005–2012; USDA/HHS, 2016.

Suggested Citation:"Appendix L: Gap Analysis." 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 L-4 Gap Analysis Summary for Breastfed WIC-Participating Infants

Nutrient EAR 5th Percentile 10th Percentile
Intake Gap Intake Gap
Iron (mg/d) 6.9 2.1 4.8 3.1 3.8
Zinc (mg/d) 2.5 0.5 2.0 0.9 1.6

NOTES: N = 39. EAR = Estimated Average Requirement; UL = Tolerable Upper Intake Level.

SOURCES: IOM, 2001; USDA/ARS, 2009–2012.

TABLE L-5 Gap Analysis Summary for WIC-Participating Children Ages 1 to Less Than 2 Years: Nutrients with Inadequacy or Excess Greater Than 50 Percent

Nutrient AI, 1–3 y Median UL 95th Percentile
Intake Gap Intake Gap
Potassium (mg/d) 3,000 1,864 1,136
Fiber (g/d) 19 8 11
Sodium (mg/d) 1,000 1,615 0 1,500 2,306 806

NOTES: N = 96. — = not applicable (UL gap only evaluated for sodium, for which intakes exceed the UL); AI = Adequate Intake; UL = Tolerable Upper Intake Level. The shaded nutrient (sodium) is a nutrient to limit.

SOURCES: IOM, 2005, 2002/2005; USDA/ARS, 2011–2012.

Suggested Citation:"Appendix L: Gap Analysis." 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 L-6 Gap Analysis Summary for WIC-Participating Children Ages 2 to Less Than 5 Years: Nutrients with Inadequacy or Excess Greater Than 50 Percent

Nutrient AI, 1–3 Years AI, 4–5 Years Median UL, 1–3 Years UL, 4–5 Years 95th Percentile
Intake Gap, 2–3 Years Gap, 4–5 Years Intake Gap, 2–3 Years Gap, 4–5 Years
Potassium (mg/d) 3,000 3,800 2,071 929 1,729
Fiber (g/d) 19 25 12 7 13
Sodium (mg/d) 1,000 1,200 2,118 0 0 1,500 1,900 2,995 1,495 1,095
Saturated fat (g/d) 14 14 29 15 15
Added sugars (g/d) 32 32 91 59 59

NOTES: N = 263. — = not applicable; AI = Adequate Intake; UL = Tolerable Upper Intake Level. Shaded nutrients are nutrients to limit; for these, the gaps to reduce the prevalence of excessive intake to 5 percent were evaluated. For sodium, this is the 95th percentile gap compared to the UL. For saturated fat and added sugar, the 95th percentile intakes are compared to the Dietary Guidelines for Americans upper limit of 10 percent of kcal.

SOURCES: IOM, 2005, 2002/2005; USDA/ARS, 2011–2012; USDA/HHS, 2016.

Suggested Citation:"Appendix L: Gap Analysis." 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

IOM (Institute of Medicine). 1997. Dietary Reference Intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy Press.

IOM. 1998. Dietary Reference Intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline. Washington, DC: National Academy Press.

IOM. 2000. Dietary Reference Intakes for vitamin C, vitamin E, selenium, and carotenoids. Washington, DC: National Academy Press.

IOM. 2001. Dietary Reference Intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press.

IOM. 2002/2005. Dietary Reference Intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. Washington, DC: The National Academies Press.

IOM. 2005. Dietary Reference Intakes for water, potassium, sodium, chloride, and sulfate. Washington, DC: The National Academies Press.

IOM. 2011. Dietary Reference Intakes for calcium and vitamin D. Washington, DC: The National Academies Press.

USDA/ARS (U.S. Department of Agriculture/Agriculture Research Service). 2005–2012. What We Eat in America, NHANES 2005–2012. http://www.cdc.gov/nchs/nhanes/wweia.htm (accessed November 29, 2016).

USDA/ARS. 2009–2012. What We Eat in America, NHANES 2009–2012. http://www.cdc.gov/nchs/nhanes/wweia.htm (accessed November 29, 2016).

USDA/ARS. 2011–2012. What We Eat in America, NHANES 2011–2012. http://www.cdc.gov/nchs/nhanes/wweia.htm (accessed November 29, 2016).

USDA/HHS (U.S. Department of Agriculture/U.S. Department of Health and Human Services). 2016. 2015–2020 Dietary Guidelines for Americans. https://health.gov/dietaryguidelines/2015 (accessed August 29, 2016).

Suggested Citation:"Appendix L: Gap Analysis." 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 L: Gap Analysis." 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 682
Suggested Citation:"Appendix L: Gap Analysis." 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 683
Suggested Citation:"Appendix L: Gap Analysis." 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 684
Suggested Citation:"Appendix L: Gap Analysis." 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 685
Suggested Citation:"Appendix L: Gap Analysis." 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 686
Suggested Citation:"Appendix L: Gap Analysis." 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 687
Suggested Citation:"Appendix L: Gap Analysis." 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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Review of WIC Food Packages: Improving Balance and Choice: Final Report Get This Book
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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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