Dietary Risk Assessment in the WIC Program (2002) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-12
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since its inception. The WIC program, which provides nutritious supplemental foods, nutrition education, and health referral services to low-income pregnant or postpartum women, infants, and children to age 5 years, requires applicants to meet one of several nutrition risk categories in order to be eligible for program services, dietary risk is one of these categories.
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These are the two types of dietary risk that WIC personnel use extensively as the sole basis for determining that postpartum women and children are at nutritional risk. Failure to meet Dietary Guidelines refers to the 10 guidelines in the Dietary Guidelines for Americans (USDA/HHS, 2000, see Box ESPY.
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In particular, it contracted with the IOM's Food and Nutrition Board to evaluate the use of various dietary assessment tools and to make recommendations for the assessment of inadequate or inappropriate dietary patterns, especially in the category failure to meet Dietary Guidelines. The Food and Nutrition Service asked that an expert committee propose a framework for assessing dietary risk among WIC applicants and identify and prioritize areas of greatest concern when the Dietary Guidelines are incorporated in WIC.
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However, since the Dietary Guidelines apply only to individuals ages 2 years and older, the focus is on pregnant and postpartum women and children. CURRENT PRACTICES Since standardized criteria have not yet been established for failure to meet Dietary Guidelines or inadequate diets, state WIC agencies currently select the method and cut-off points to be used by their agencies.
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. FINDINGS AND RECOMMENDATION Findings Basing Risk Criteria on the Dietary Guidelines Focusing on the single guideline Let the Pyramid Guide Your Food Choices was determined to be the most feasible, comprehensive, and objective approach to using the Dietary Guidelines for establishing dietary risk for those individuals 2 years of age and older.
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Nearly all U.S. women and children usually consume fewer than the recommended number of servings specified by the Food Guide Pyramid and, therefore, would be at dietary risk based on the criterion failure to meet Dietary Guidelines that is described in Finding 1.
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Even research-quality dietary assessment methods are not sufficiently accurate or precise to distinguish an individual's eligibility status using criteria based on the Food Guide Pyramid or on nutrient intake. Physical Activity Assessment Because the committee was asked to identify areas of concern when the Dietary Guidelines were incorporated into WIC and because the Guidelines include a quantitative recommendation for physical activity levels for adults and for children 2 years of age and older, the committee considered physical activity assessment as a part of dietary risk assessment.
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Finding 4. Physical activity assessment methods are not sufficiently accurate or reliable to distinguish individuals who are ineligible from those who are eligible for WIC services based on the physical activity component of the Dietary Guidelines.
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Tools currently used for dietary risk assessment appear to have very high sensitivity in that they identify nearly everyone as failing to meet the Dietary Guidelines, but low specificity poor ability to identify persons who are not at dietary risk. No known dietary or physical activity assessment methods or behavioral indicators of diet or physical activity hold promise of accurately identifying the small percentage of women and children who do meet the proposed criterion based on the Food Guide Pyramid or the physical activity recommendation.
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. Group dietary intake information for a WIC population (e.g., data from a recent national dietary survey such as the National Health and Nutrition Examination Survey or the Continuing Survey of Food Intakes by Individuals or data collected in a special WIC study)
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Further, due to the complex nature of dietary patterns, it is unlikely that a tool will be developed to fulfill its intended purpose within WIC: to classify individuals accurately with respect to their true dietary risk. Thus, any tools adopted would result in misclassification of the eligibility status of some, potentially many, individuals.
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