WIC Food Packages Time for a Change (2006) / Chapter Skim
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Appendix D Evaluating Potential Benefits and Risks of the Revised Food Packages
Appendix D Evaluating Potential Benefits and Risks of the Revised Food Packages
Pages 291-313
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From page 291... ...
Chapter 6 -- How the Revised Food Packages Meet the Criteria Specified -- addresses ways in which the revised packages provide 1Failure to meet the Dietary Guidelines for Americans was identified as a nutrition risk criteria for the WIC program (IOM, 1996)
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From page 292... ...
Assuming that the recommendations in this report are adopted at the federal level, those benefits and risks would depend upon many factors, including the following: · The extent to which the WIC state agencies allow local agencies to prescribe the maximum amounts of food in the revised food packages; · The extent to which the WIC state agencies incorporate more allowed choices in the food package offerings; · The success of approaches to nutrition education that address the revised food packages; · The extent of redemption of the WIC food instruments for the revised packages; · Whether the entire amount of food in the package is consumed by the WIC participant; and · The association of consuming those foods with long-term health benefits. Notably, the committee used current dietary guidance from the Dietary Guidelines and Dietary Reference Intakes (DRIs)
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From page 293... ...
In this case, exposure assessment for each WIC population addresses the changes in usual nutrient intake distributions that result from changes in individual intakes that are based on the changes in the nutrients provided by the revised food packages. As the final step in risk assessment, risk characterization reflects the integration of the previous three steps in order to help inform decision makers about quantitative levels of risk to human health status under different scenarios.
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From page 294... ...
to provide a quantitative description (that is, a modified risk characterization) of the potential change in nutritional status of the WIC population as the result of the recommended changes in the WIC food packages.
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From page 295... ...
. Thus, the analysis of benefits and risks would start with the existing distribution of usual nutrient intake of WIC participants (which presumably reflects the existing intrahousehold allocation of WIC food packages)
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From page 296... ...
Given that the mean intake of calcium is less than the amount currently offered, it is not reasonable to assume that a change in the amount of calcium offered through a revised WIC food package will lead to the same quantitative change in mean intake. Results of analyses with this approach are reported in Tables D-1A through D-1C at the end of this appendix; because of the concerns in the application of the delta approach, the consideration of risks and benefits of the revised food packages will focus on results from the committee's second approach to predicting changes in population intake of nutrients -- the proportional approach.
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From page 297... ...
The current and revised WIC food packages contain insignificant amounts of industrial trans fats -- the source of trans fat deemed to be of concern by the Dietary Guidelines Advisory Committee (DHHS/USDA, 2004)
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From page 298... ...
The committee characterized changes in nutrients available in each package and estimated how these changes would influence predicted nutrient intake. Tables detailing changes in predicted intake of more than 30 micro- and macronutrients plus cholesterol and food energy for each of the current and revised WIC food packages are in Appendix C -- Nutrient Profiles.
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From page 299... ...
. The method used to set the ULs for zinc resulted in relatively narrow margins between the UL and the Recommended Dietary Allowance (RDA)
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From page 300... ...
. Food Package VII -- Fully Breastfeeding Women -- The revised Food Package VII is intended both to enhance maternal nutrition in support of breastfeeding and (combined with changes in other packages)
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In addition, given the importance of assessing the benefits and risks of the revised WIC food packages, the committee recommends that USDA conduct pilot studies and randomized, controlled trials to estimate the changes in the usual nutrient intake distribution and the resulting changes in the prevalence of inadequacy and excessive intakes (see Chapter 7-Recommendations for Implementation and Evaluation)
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From page 302... ...
Risks · Specific changes in allowed foods could lead to decreased consumption of certain WIC foods. The change from whole milk to fat-reduced milks could lead to lower milk consumption, and the requirement that grain products be whole grain could lead to lower grain consumption -- especially if nutrition education efforts are not implemented to decrease these possibilities.
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From page 303... ...
The committee anticipates that the set of revised food packages will provide a clear net benefit to WIC participants. The following is a list of tables presented in this appendix.
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From page 304... ...
304 WIC FOOD PACKAGES TABLE D-1A Comparison of Current and Revised Food Packages: Nutrients of Concern with Regard to Inadequate Intake Current Food Package, Usual Intakea Participant Category and Priority Nutrient EAR or AI* Mean Infants, 611.9 mo, breast-fed Food Package No.
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From page 305... ...
APPENDIX D 305 Current Food Revised Food Revised Food Package, Predicted Usual Intakeb Packagea Packageb 25th 75th Predicted Mean Percentile Median Percentile %Inadequate %Inadequate Revised II-BF Current II Revised II-BF 10.9 5.5 9.5 14.7 39.5 34.0 4.0 2.5 3.9 5.2 60.3 25.4 Revised IV-A Current IV Revised IV-A 13.2 9.4 12.4 16.2 1.6 0.9 1,885 1,506 1,827 2,195 -- -8.0 5.5 7.2 9.7 55.3 18.5 12.3 10.3 12.3 14.4 -- - Revised IV-B Current IV Revised IV-B 15.0 11.9 14.6 17.6 0.4 0.1 2,078 1,651 2,022 2,438 -- -8.7 6.4 8.1 10.5 47.0 11.4 15.4 12.9 15.1 17.6 -- - Revised V Current V Revised V 934 721 902 1,113 -- -19.3 15.6 18.5 22.2 7.5 3.4 349 292 341 398 49.4 20.3 3,052 2,548 3,005 3,506 -- -14.3 11.2 14.4 16.9 94.4 43.6 25.6 21.0 24.8 29.2 -- -1,041 741 987 1,277 31.2 20.2 119 63 97 154 32.7 43.5 -- -- -- -- -- -2.4 1.9 2.3 2.8 34.0 11.9 633 469 606 761 41.5 29.2 continues
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306 WIC FOOD PACKAGES TABLE D-1A Continued Current Food Package, Usual Intakea Participant Category and Priority Nutrient EAR or AI* Mean Non-breastfeeding postpartum women, 1444 y Food Package No.
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APPENDIX D 307 Current Food Revised Food Revised Food Package, Predicted Usual Intakeb Packagea Packageb 25th 75th Predicted Mean Percentile Median Percentile %Inadequate %Inadequate Revised VI Current VI Revised VI 593 466 570 694 -- -16.0 14.6 16.0 17.4 9.5 4.6 246 216 243 273 87.5 66.0 2,156 1,859 2,129 2,424 -- -12.5 11.0 12.6 14.1 99.8 40.4 18.6 15.6 18.0 21.0 -- -655 488 633 797 44.1 26.9 77 47 69 98 42.2 47.1 -- -- -- -- -- -1.7 1.5 1.7 2.0 17.1 2.4 543 434 530 633 12.0 5.0 Current VII Revised VII 984 760 952 1,173 -- -18.7 14.8 18.0 21.6 7.5 4.2 330 273 322 379 49.4 29.1 2,909 2,404 2,861 3,361 -- -13.4 10.2 13.0 16.4 94.4 54.3 22.9 18.4 22.1 26.6 -- -881 589 812 1,098 31.2 35.7 107 55 85 137 32.7 51.9 -- -- -- -- -- -2.3 1.8 2.2 2.7 34.0 15.8 601 438 570 726 41.5 35.5
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308 WIC FOOD PACKAGES TABLE D-1B Comparison of Current and Revised Food Packages: Nutrients of Concern with Regard to Excessive Intake Current Food Package, Usual Intakea UL, Participant Category and Mean EER, Priority Nutrient or AMDR Mean WIC Infants, 03.9 mo, formula-fed Food Package No. CurrentI Zinc, mg/d 4.0 6.1 Preformed vitamin A, mcg/d 600 581 Food energy, kcal/d 555f 673 WIC Infants, 45.9 mo, formula-fed Food Package No.
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From page 309... ...
APPENDIX D 309 Current Food Revised Food Revised Food Package, Predicted Usual Intakeb Packagea Packageb Predicted 25th 75th %>UL or %>UL or Mean Percentile Median Percentile %>AMDR %>AMDR Revised I-FF-A Current I Revised I-FF-A 6.1 4.6 5.8 7.2 86.0 86.0 581 445 547 677 38.3 38.3 673 523 635 778 -- - Revised I-FF-B Current II Revised I-FF-B 6.1 4.9 5.9 7.1 96.8 91.5 666 573 660 752 56.3 68.0 721 602 704 820 -- - Revised II-FF Current II Revised II-FF 6.2 4.9 6.0 7.4 87.6 72.3 530 358 470 644 42.7 29.5 877 705 853 1,021 -- - Revised IV-A Current IV Revised IV-A 8.7 6.6 8.3 10.3 55.7 68.8 1,733 1,217 1,641 2,145 63.5 58.4 304 207 270 350 25.0 5.1 1,248 1,026 1,222 1,441 -- - Revised IV-B Current IV Revised IV-B 10.3 8.3 10.0 11.9 58.1 72.6 2,440 1,949 2,363 2,851 92.8 90.1 405 291 358 449 16.1 7.2 1,460 1,188 1,429 1,697 -- - Revised V Current V Revised V 3,241 2,850 3,218 3,606 97.2 95.8 2,082 1,762 2,054 2,372 -- -68.8 56.6 67.7 79.9 -- - 27.2 24.6 27.1 29.6 24.5 1.4 continues
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From page 310... ...
310 WIC FOOD PACKAGES TABLE D-1B Continued Current Food Package, Usual Intakea UL, Participant Category and Mean EER, Priority Nutrient or AMDR Mean Non-breastfeeding postpartum women, 1444 y Food Package No. Current VI Sodium, mg/d 2,300 2,912 Food energy, kcal/d 2,163f 1,774 Total fat, g/d na 66.1 Total fat, % of food energy 2535, <19 y } 33.1 2035, 19 y Lactating women, 1444 ye Food Package No.
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From page 311... ...
APPENDIX D 311 Current Food Revised Food Revised Food Package, Predicted Usual Intakeb Packagea Packageb Predicted 25th 75th %>UL or %>UL or Mean Percentile Median Percentile %>AMDR %>AMDR Revised VI Current VI Revised VI 2,646 2,319 2,623 2,948 90.7 76.4 1,674 1,442 1,654 1,885 -- -57.4 51.4 57.0 62.9 -- - 24.6 23.8 24.6 25.4 4.9 <0.1 Revised VII Current VII Revised VII 3,267 2,877 3,245 3,633 97.2 96.3 2,037 1,717 2,009 2,327 -- -67.4 55.1 66.3 78.4 -- - 27.6 25.3 27.5 29.8 24.5 1.6
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From page 312... ...
-tocopherol equivalents; DFE = dietary folate equivalents; EAR = Estimated Average Requirement, used when available; EER = Estimated Energy Requirement; kcal = kilocalories; na = not applicable; N/A = not available, intake data were not available for vitamin D; RAE = retinol activity equivalents; UL = Tolerable Upper Intake Level; %Inadequate = percentage with inadequate intakes as estimated from percentage with usual intake less than EAR; %>AMDR = percentage with usual intake greater than AMDR; %>UL = percentage with usual intake greater than UL. aObserved usual intakes were calculated using 19941996 and 1998 CSFII data.
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From page 313... ...
and the Dietary Guidelines for Americans 2005 (DHHS/USDA, 2005)
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